Open pelvic lymph node dissection for prostate cancer : a reassessment.
To provide a risk-to-benefit analysis of open staging pelvic lymph node dissection (PLND) for prostate cancer.
The medical records of all patients presenting with prostate cancer from July 1989 to April 1994 were reviewed.
A total of 245 patients with clinically localized disease were selected to undergo radical retropubic prostatectomy (RRP) preceded by open PLND.
Univariate and multivariate analyses were performed to evaluate the predictive value of the preoperative serum prostate-specific antigen (PSA) concentration, clinical stage, and Gleason score with regard to final nodal status.
The cost and morbidity associated with PLND in the setting of RRP was also defined.
Overall, only 16 patients had lymph node metastases.
Lymph node involvement correlated significantly with elevated serum PSA values (P=0.0001), high Gleason score (P=0.0022), and advanced clinical stage (P=0.0001).
Lymph node metastases were particularly uncommon in patients with nonpalpable tumors (1 of 67 [1.5% ]], PSA values less than 10 (2 of 154 [1.3% ]), and Gleason score less than 6 (1 of 26 [3.8% ]). Overall, 179 patients presented with at least one or more of these favorable characteristics, and only 4 (2.2%) had lymph node involvement.
The cost per metastasis diagnosed in patients with low-risk characteristics was approximately 543,600.
An open staging PLND may no longer be justified on a routine basis in patients undergoing radical retropubic prostatectomy.
Mots-clés Pascal : Epithélioma, Prostate, Prostatectomie, Lymphadénectomie, Analyse avantage coût, Evaluation, Economie santé, Traitement, Technique, Adulte, Homme, Mâle, Appareil urinaire pathologie, Appareil génital mâle pathologie, Prostate pathologie, Tumeur maligne, Chirurgie
Mots-clés Pascal anglais : Carcinoma, Prostate, Prostatectomy, Lymphadenectomy, Cost benefit analysis, Evaluation, Health economy, Treatment, Technique, Adult, Human, Male, Urinary system disease, Male genital diseases, Prostate disease, Malignant tumor, Surgery
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 95-0529887
Code Inist : 002B25H. Création : 01/03/1996.