고위험도 전립선암 환자의 치료 편집하기 (부분)

== 근거표 ==
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!KQ13
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!Reference
|1. Abdollah F, Gandaglia G, Suardi N, Capitanio U, Salonia A, Nini A, Moschini M, Sun M, Karakiewicz PI, Shariat SF, Montorsi F, Briganti A More extensive pelvic lymph node dissection improves survival in patients with node-positive prostate cancer. Eur Urol 2015;67(2):212-9.
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!Study type
|Multicenter longitudinal Observational Study
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!Patients
|315 pN1 PCa patients treated with radical prostatectomy (RP) and anatomically ePLND between 2000 and 2012 at one tertiary care centre
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!Purpose of Study
|The relationship between the number of removed lymph nodes (RLNs) and cancer-specific mortality (CSM) was tested in patients with LNI
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!Study Results
| The average number of RLNs was 20.8 (median: 19; interquartile range: 14-25). Mean and median follow-up were 63.1 and 54 mo, respectively. At 10-yr, the CSM-free survival rate was 74.7%, 85.9%, 92.4%, 96.0%, and 97.9% for patients with 8, 17, 26, 36, and 45 RLNs, respectively. By multivariable analyses, the number of RLNs independently predicted lower CSM rate (hazard ratio [HR]: 0.93; p=0.02). Other predictors of CSM were Gleason score 8-10 (HR: 3.3), number of positive nodes (HR: 1.2), and aRT treatment (HR: 0.26; all p≤0.006). The study is limited by its retrospective nature.
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!Level of Study
|4
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!Reference
|2. Ledezma RA, Negron E, Razmaria AA, Dangle P, Eggener SE, Shalhav AL, Zagaja GP. Robotic-assisted pelvic lymph node dissection for prostate cancer: frequency of nodal metastases and oncological outcomes. World Journal of Urology 2015;33(11):1689-94.
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!Study type
|Multicenter longitudinal observational Study
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!Patients
|1,740 consecutive patients who underwent RALP and extended PLND
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!Purpose of Study
| determine the frequency of pelvic lymph node metastasis and oncological outcomes following RALP with PLND in patients who did not receive adjuvant androgen deprivation therapy (ADT)
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!Study Results
| One hundred and eight patients (6%) with positive LNs were identified. The median number of LNs removed was 17 (IQR 11-24), and median follow-up was 26 months (IQR 14-43). Ninety-one (84%) patients did not receive adjuvant ADT of whom 60% had BCR with a median time to recurrence of 8 months. The 1- and 3-year BCR-free probability was 42 and 28%, respectively. Patients with <=2 LN+ had significantly better biochemicalfree estimated probability compared to those with >2 LN+ (p=0.002). The total number of LN+ (HR=1.1; 95% CI 1.01-1.2, p=0.04) and Gleason 8-10 (HR=1.96; 95% CI 1.1-3.4, p=0.02) were predictors of BCR on multivariate analysis.
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!Level of Study
|4
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!Reference
|3. Muck A, Langesberg C, Mugler M, Rahnenführer J, Wullich B, Schafhauser W. Clinical outcome of patients with lymph node-positive prostate cancer following radical prostatectomy and extended sentinel lymph node dissection. Urol Int. 2015;94(3):296-306 
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!Study type
|longitudinal observational study
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!Patients
|819 patients with clinically localized PCa, confirmed by biopsy, were treated with RRP plus eSLND
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!Purpose of Study
|evaluate the clinical outcome after extended sentinel lymph node dissection (eSLND) and radical retropubic prostatectomy (RRP) in patients with clinically localized prostate cancer (PCa)
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!Study Results
|The mean follow-up was 5.3 years. Lymph node (LN) metastases occurred in 140 patients. We removed an average of 10.9 LNs via eSLND from patients with pN1 PCa. Postoperatively, 121 pN1 patients temporarily received adjuvant androgen deprivation therapy. The mean survival periods for RFS, RFS after secondary treatment, CSS, and OS were 4.7, 7.0, 8.8, and 8.1 years, respectively. The cancer-specific death rate of the 140 pN1 patients was 13.6%. RFS, CSS, and OS were significantly correlated with pathological margin status, LN density, the total diameter of evident metastases, and membership in the subgroup ‘micrometastases only’.
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!Level of Study
|4
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!Reference
|4. Moschini M, Fossati N, Abdollah F, Gandaglia G, Cucchiara V, Dell’Oglio P, Luzzago S, Shariat SF, Dehò F, Salonia A, Montorsi F, Briganti A. Determinants of long-term survival of patients with locally advanced prostate cancer: the role of extensive pelvic lymph node dissection. Prostate Cancer Prostatic Dis 2016;19(1):63-7.
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!Study type
|longitudinal observational study
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!Patients
|1,586 pT3-T4 PCa patients treated with RP and extended PLND between 1987 and 2012
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!Purpose of Study
|Assessing the impact of more extensive PLND on cancer-specific mortality (CSM) in patients treated with surgery for locally advanced PCa.
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!Study Results
|The average number of nodes removed was 19 (median: 17; interquartile range: 1123). Mean and median follow-up were 80 and 72 months, respectively. At multivariable analyses, Gleason score 8-10 (hazard ratio (HR): 2.5) and a higher number of positive nodes (HR: 1.06) were independently associated with higher CSM rate (all P<0.05). Conversely, higher number of removed LNs (HR: 0.94) and adjuvant radiotherapy (HR: 0.54) were independent predictors of lower CSM rates (all P≤0.03).
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!Level of Study
|4
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!Reference
|5. Fossati N, Willemse PM, Van den Broeck T, van den Bergh RCN, Yuan CY, Briers E, Bellmunt J, Bolla M, Cornford P, De Santis M, MacPepple E, Henry AM, Mason MD, Matveev VB, van der Poel HG, van der Kwast TH, Rouvière O, Schoots IG, Wiegel T, Lam TB, Mottet N, Joniau S. The Benefits and Harms of Different Extents of Lymph Node Dissection During Radical Prostatectomy for Prostate Cancer: A Systematic Review. Eur Urol 2017;72(1):84-109.
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!Study type
|Systematic Review
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!Patients
|29 studies were included. Specifically, 21 studies (15 full-text articles and six conference abstracts) compared no PLND versus any form of PLND, whereas eight studies (four fulltext articles and four conference abstracts) compared lPLND or sPLND versus ePLND or sePLND.
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!Purpose of Study
|To systematically review the relevant literature assessing the relative benefits and harms of PLND for oncological and non-oncological outcomes in patients undergoing radical prostatectomy for PCa.
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!Study Results
|Overall, 66 studies recruiting a total of 275,269 patients were included (44 full-text articles and 22 conference abstracts). Oncological outcomes were addressed by 29 studies, one of which was a randomized clinical trial (RCT). Non-oncological outcomes were addressed by 43 studies, three of which were RCTs. There were high risks of bias and confounding in most studies. Conflicting results emerged when comparing biochemical and clinical recurrence, while no significant differences were observed among groups for survival. Conversely, the majority of studies showed that the more extensive the PLND, the greater the adverse outcomes in terms of operating time, blood loss, length of stay, and  postoperative complications. No significant differences were observed in terms of urinary continence and erectile function recovery.
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!Level of Study
|1
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!Reference
|6. Narita T, Koie T, Ookubo T, Mitsuzuka K, Narita S, Yamamoto H, Inoue T, Hatakeyama S, Kawamura S, Tochigi T, Habuchi T, Arai Y, Ohyama C. The impact of extended lymph node dissection versus neoadjuvant therapy with limited lymph node dissection on biochemical recurrence in high-risk prostate cancer patients treated with radical prostatectomy: a multiinstitutional analysis. Med Oncol 2017;34(1):1.
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!Study Results
|Multicenter non-randomized longitudinal observational Study
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!Patients
|2,403 consecutive Pca patients treated with RP
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!Purpose of Study
|To assess whether e-PLND confers an oncological benefit for high-risk Pca compared to neoadjuvant luteinizing hormone-releasing hormone and estramustine (LHRH + EMP)
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!Study Results
|In the e-PLND group, we identified 238 high-risk Pca patients who underwent RP and e-PLND, with lymphatic tissue removal around the obturator and the external iliac regions, and hypogastric lymph node dissection. The neoadjuvant therapy with limited PLND (l-PLND) group included 280 high-risk Pca patients who underwent RP and removal of the obturator node chain between September 2005 and June 2014 at Hirosaki University. The outcome measure was BRFS. The 5-year biochemical recurrence-free survival rates for the neoadjuvant therapy with l-PLND group and e-PLND group were 84.9 and 54.7%, respectively (P<0.0001). The operative time was significantly longer in the e-PLND group compared to that of the neoadjuvant therapy with l-PLND group. Grade 3/4 surgeryrelated complications were not identified in both groups.
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!Level of Study
|4
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