| Part Ⅰ Cohort report of radical prostatectomy with pelvic lymphadenectomyObjective: To explore the significance of pelvic lymph node dissection in the treatment of prostate cancer based on the cohort data of Chinese patients.Methods: The clinical data of 1502 patients who underwent radical prostatectomy by a single surgeon at Department of Urology,the First Affiliated Hospital of Naval Medical University from February 2009 to April 2021 were retrospectively collected.Excluding 28 patients with missing clinical information,1474 patients with complete preoperative clinical data and pelvic lymph node resection information records were included.Descriptive statistics were used to compare the clinical characteristics and the trend of pelvic lymph node dissection.Logistic regression was used to analyze the related factors of radical prostatectomy combined with pelvic lymph node resection and the related risk factors of prostate cancer with pelvic lymph node metastasis.X~2 analysis was used to compare the difference of positive lymph node detection rate under different extent of pelvic lymph node dissection.The propensity score matching(PSM)method was used to eliminate the differences in baseline characteristics between the two groups in survival analysis.KaplanMeier survival curve and Log-rank statistical analysis were used to explore the effect of pelvic lymph node dissection on the oncological prognosis of prostate cancer patients.Results: Among 1474 patients,956 patients(64.9%)underwent pelvic lymph node dissection,and 159 patients(16.6%)had lymph node involvement.The positive lymph node detection rate of extended lymph node dissection was higher than that of obturator lymph node dissection,and the difference was statistically significant(20.6% vs 10.1%,P<0.001).Multivariate Logistic regression analysis showed that serum PSA(OR=1.034 95%CI: 1.023-1.045,P<0.001),ISUP group(OR=1.596 95%CI: 1.419-1.795,P<0.001),clinical T stage(OR=0.719 95%CI: 0.576-0.897,P=0.003)and risk stratification(OR=1.419 95%CI: 1.088-1.85,P=0.01)were the risk factors related to pelvic lymph node resection in radical prostatectomy.ISUP group(OR=1.501 95%CI: 1.255-1.796,P<0.001),clinical T stage(OR=1.726 95%CI: 1.337-2.228,P<0.001)and risk stratification(OR=8.863 95%CI: 2.123-36.996,P=0.003)were the risk factors of pelvic lymph node metastasis.Before PSM,Kaplan-Meier survival analysis showed that the biochemical recurrence progression in RP alone group was better than that in RP combined with PLND group(P<0.001),and the biochemical recurrence progression in obturator lymph node resection group was better than that in extended lymph node resection group(P=0.007).After PSM,there was no significant difference in the prognosis between RP alone group and RP combined with PLND group(P=0.798),and there was no significant difference in the prognosis between the obturator lymph node dissection group and the extended lymph node dissection group(P=0.16).The progression-free survival of the adjuvant therapy group with positive lymph nodes was better than that of the non-adjuvant therapy group,and the difference was statistically significant(P<0.001).The progression-free survival of the adjuvant therapy group with positive lymph nodes was better than that of the non-PLND group(P=0.022).Conclusion: Extended pelvic lymph node dissection is recommended for patients with higher ISUP group,later clinical stage and higher risk stratification,which can significantly improve the detection rate of positive lymph nodes.Adjuvant therapy for patients with lymph node metastasis can effectively prolong the prognosis.Part Ⅱ Comparison of the clinical efficacy of different versions of Briganti nomogramObjective: To compare the clinical efficacy of different versions of Briganti nomogram in predicting lymph node metastasis in Chinese prostate cancer patients undergoing radical prostatectomy with extended pelvic lymph node dissection.Methods: From October 2012 to April 2021,583 cases with prostate cancer who underwent radical prostatectomy and pelvic lymphadenectomy by a single surgeon at Department of Urology,the First Affiliated Hospital of Naval Medical University were retrospectively collected.For all 583 patients,the median age was 67(ranging 63~72)years old,median BMI was 24.39(ranging 22.58~26.35)kg/m~2,median PSA was 22(ranging 12~43)ng/ml.There were 65 cases,357 cases,140 cases and 21 cases with clinical stage T1,T2 and T3.There were 30 cases,109 cases,104 cases,160 cases and 180 cases for ISUP 1 group,2 group,3 group,4 group and 5 group.The median percentage of positive biopsy cores was 50%(ranging 33%-83%).The validated nomograms were Briganti 2006,2012 and 2017.Compared with the 2006 edition,the new variables in the 2012 edition and 2017 edition were the percentage of positive biopsy cores,the percentage of the highest grade positive biopsy cores and the percentage of the lower grade positive biopsy cores,respectively.The validation patients for the 2006,2012 and 2017 versions of nomogram were 560,513 and 357,respectively,which were used as the differential validation cohorts.A total of 357 patients were validated for all three versions of nomogram,which was considered as the general validation cohort.The area under the receiver operating characteristic(ROC)curve(AUC),calibration curve and clinical decision curve analysis were used to evaluate the predictive efficacy of the three versions of nomograms,the AUC values of different versions of nomogram were tested by non-parametric test.Results: In the differential validation cohort,the AUC values of the 2006,2012 and 2017 versions of the nomogram were 0.738(95%CI 0.690-0.785),0.765(95%CI 0.717-0.814)and 0.779(95%CI 0.724-0.834),respectively.There was no significant difference in AUC values among versions(P>0.05).In the general validation cohort,the AUC values of the three versions of the nomogram were as follows: 0.744(95%CI 0.682-0.805),0.759(95%CI 0.700-0.818)and 0.779(95%CI 0.724-0.834),respectively.There was no significant difference in AUC values among the three versions(P>0.05).The calibration curve shows that the prediction probability of 2012 and 2017 editions is in good agreement with the actual risk within the prediction probability of 0~40%.Analysis of the clinical decision curve showed that the clinical benefit of the 2012 version was greater than that of the other two versions in the prediction threshold of 0~33%.Conclusion: Briganti nomogram is suitable for predicting pelvic lymph node metastasis in Chinese patients with prostate cancer.The 2012 and 2017 versions of the nomogram have good predictive performance,and the versions can be selected according to the predictive variables that can be provided. |
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