Abstract：
BACKGROUND: The therapeutic role of pelvic lymph node dissection (PLND) during radical prostatectomy (RP) for prostate cancer is not established. In clinical practice, PLND is primarily performed in cases of high-risk prostate cancer. The detection of lymph node metastasis plays a crucial role in determining the need for subsequent treatments. This study aims to evaluate the prognosis of prostate cancer patients with lymph node involvement (LNI) by stratifying them based on postoperative prostate-specific antigen (PSA) levels to identify biomarkers that can guide postoperative treatment strategies.
METHODS: Analysis was conducted on 383 patients, selected from 572 initially eligible, who underwent RP with LNI across 33 Japanese Urological Oncology Group institutions from 2006 to 2019. Patients were grouped according to postoperative PSA levels and salvage treatments received. Follow-up focused on castration resistance-free survival (CRFS), metastasis-free survival (MFS), and overall survival (OS).
RESULTS: In the persistent PSA group (PSA ≥ 0.1 ng/mL), CRFS and MFS were significantly shorter compared to the non-persistent PSA group (PSA < 0.1 ng/mL), and there was a tendency for shorter OS. In the persistent PSA group, patients with postoperative PSA values above the median (PSA ≥ 0.52 ng/mL) showed shorter CRFS and MFS. Furthermore, in the PSA ≥ 0.52 group, androgen deprivation therapy (ADT) plus radiotherapy (RT) combination had prolonged CRFS and MFS compared with ADT alone.
CONCLUSIONS: This study provides valuable insights into stratifying patients based on postoperative PSA levels to tailor postoperative treatment strategies, potentially improving the prognosis of prostate cancer patients with LNI.
METHODS: Analysis was conducted on 383 patients, selected from 572 initially eligible, who underwent RP with LNI across 33 Japanese Urological Oncology Group institutions from 2006 to 2019. Patients were grouped according to postoperative PSA levels and salvage treatments received. Follow-up focused on castration resistance-free survival (CRFS), metastasis-free survival (MFS), and overall survival (OS).
RESULTS: In the persistent PSA group (PSA ≥ 0.1 ng/mL), CRFS and MFS were significantly shorter compared to the non-persistent PSA group (PSA < 0.1 ng/mL), and there was a tendency for shorter OS. In the persistent PSA group, patients with postoperative PSA values above the median (PSA ≥ 0.52 ng/mL) showed shorter CRFS and MFS. Furthermore, in the PSA ≥ 0.52 group, androgen deprivation therapy (ADT) plus radiotherapy (RT) combination had prolonged CRFS and MFS compared with ADT alone.
CONCLUSIONS: This study provides valuable insights into stratifying patients based on postoperative PSA levels to tailor postoperative treatment strategies, potentially improving the prognosis of prostate cancer patients with LNI.
摘要：
背景：盆腔淋巴结清扫术（PLND）在前列腺癌根治性前列腺切除术（RP）中的治疗作用尚未确定。在临床实践中,PLND主要在高风险前列腺癌的情况下进行。淋巴结转移的检测在确定是否需要后续治疗中起着至关重要的作用。这项研究旨在通过根据术后前列腺特异性抗原（PSA）水平对淋巴结受累（LNI）的前列腺癌患者进行分层，以确定可以指导术后治疗策略的生物标志物，从而评估其预后。
方法：对383例患者进行分析，从最初符合条件的572人中选出，从2006年到2019年，他在33个日本泌尿外科肿瘤组机构中接受了LNI的RP。根据术后PSA水平和接受的抢救治疗对患者进行分组。随访重点是去势抗性无生存（CRFS），无转移生存率（MFS），总生存率（OS）。
结果：在持续PSA组（PSA≥0.1ng/mL）中，与非持续性PSA组（PSA<0.1ng/mL）相比，CRFS和MFS显著缩短，并且有较短OS的趋势。在持续性PSA组中，术后PSA值高于中位数(PSA≥0.52ng/mL)的患者的CRFS和MFS较短.此外，在PSA≥0.52组中，与单独使用ADT相比，雄激素剥夺治疗（ADT）加放疗（RT）组合的CRFS和MFS延长。
结论：这项研究为根据术后PSA水平对患者进行分层提供了有价值的见解，以调整术后治疗策略。LNI可能改善前列腺癌患者的预后。
方法：对383例患者进行分析，从最初符合条件的572人中选出，从2006年到2019年，他在33个日本泌尿外科肿瘤组机构中接受了LNI的RP。根据术后PSA水平和接受的抢救治疗对患者进行分组。随访重点是去势抗性无生存（CRFS），无转移生存率（MFS），总生存率（OS）。
结果：在持续PSA组（PSA≥0.1ng/mL）中，与非持续性PSA组（PSA<0.1ng/mL）相比，CRFS和MFS显著缩短，并且有较短OS的趋势。在持续性PSA组中，术后PSA值高于中位数(PSA≥0.52ng/mL)的患者的CRFS和MFS较短.此外，在PSA≥0.52组中，与单独使用ADT相比，雄激素剥夺治疗（ADT）加放疗（RT）组合的CRFS和MFS延长。
结论：这项研究为根据术后PSA水平对患者进行分层提供了有价值的见解，以调整术后治疗策略。LNI可能改善前列腺癌患者的预后。
