ABSTRACT
OBJECTIVES: To analyze the likelihood of undetectable PSA (< 0.01 ng/mL) after extended (ePLND) versus standard pelvic lymph-nodes dissection (sPLND) in pN+ patients. MATERIALS AND METHODS: The institutional prospectively maintained Prostate Cancer Database was queried for patients who underwent radical prostatectomy with PLND and were found with 3or less lymph-nodal metastases between 2007 and 2017. The extension of the PLND was defined according to the number of lymph-nodes (LN) removed. Patients in the 75th or higher percentile of lymph-nodes removed were considered as the ePLND group; patients in the 25th or lower percentile in the sPLND group. Groups were compared in clinical and pathological variables. Student T-test was used for comparing continuous variables; chi-square test was used for categorical variables. Multivariable logistic regression assessed the probability of undetectable PSA at 3rd month postoperatively. Kaplan-Meier method estimated the probability of biochemical recurrence. Differences between the groups were compared by Log-rank test. RESULTS: 1478 patients were treated within the time span considered. 95 with 1 to 3 lymph-nodal metastases were extracted. After accounting for inclusion criteria, 23 patients with a median of 11 LN removed were included in the sPLND group (25th percentile); 23 patients with > 27 LN were included in ePLND group (75th percentile). Surgical time was longer for ePLND. Sixteen patients (69.6%) who underwent ePLND had undetectable PSA postoperatively. At multivariable analysis, the probability of undetectable PSA at 3rd month was higher in patients who received an ePLND (HR=5.18; IC 95%=1.16-23.11; P=.03). CONCLUSIONS: ePLND is more likely to predict undetectable PSA at third month after radical prostatectomy, irrespective of disease characteristics.
Subject(s)
Lymph Node Excision , Prostate-Specific Antigen/blood , Prostatic Neoplasms/blood , Prostatic Neoplasms/pathology , Tumor Burden , Aged , Humans , Lymphatic Metastasis , Male , Middle Aged , Pelvis , Postoperative Period , Prostatectomy/methods , Prostatic Neoplasms/surgery , Retrospective StudiesABSTRACT
[Objective]To investigate the value of deep common iliac region lymphadenectomy in treatment of uterine malignancies.[Methods]88 patients with deep common iliac region lymphadenectomy in Third affiliated hospital of sun yat-sen university from March 2016 to June 2017 were enrolled in this study. The number of removed lymph nodes、metastatic lymph nodes、operative complication and so on were analyzed.[Results]The number of pelvic lymph nodes resection is from 18 to 52,the average is 26;the number of deep common iliac region lymph nodes resection is from 2 to 16,the average is 5. The number of pelvic lymph node metastasis is 11 and the rate is 12.5%;the number of deep common iliac region lymph node metastasis is 3,accounting for 27.3% of the total number of pelvic lymph node metasta-sis,which alone deep common iliac region lymph node positive in 1 case,9.0% of the total number of pelvic lymph node metastasis.The average operation time of single pelvic lymph node resection was 43 min and that of single deep common iliac region lymph nodes was 10 min.There was no severe complication.[Conclusion]Deep common iliac region lymphad-enectomy is feasibility and safety,27%of patients with pelvic lymph node metastasis has positive deep common iliac region lymph nodes,and we believe that the promotion and application of deep common iliac region lymphadenectomy can further improve the therapeutic effect of uterine malignancy.
ABSTRACT
BACKGROUND: Malignant ovarian germ cell tumours (MOGCTs) are usually detected at an early stage, with patients achieving a satisfactory prognosis. However, the role of staging surgery in the treatment of apparent early-stage MOGCTs remains controversial. AIMS: To investigate the role of staging procedures in apparent early-stage patients. MATERIALS AND METHODS: We performed a retrospective review of 102 patients who were diagnosed with MOGCTs and had malignant lesions confined to their ovaries, between January 1997 and October 2014 at the Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China. Statistical analysis was carried out using SPSS software which included survival analysis by Kaplan-Meier method and Fisher's exact test. RESULTS: Three patients relapsed and one died. The five-year overall survival rate and disease-free survival rate were 98.7% and 96.4%, respectively. Eighty-nine patients (87.3%) received adjuvant chemotherapy and only 23 patients (22.5%) were completely staged. In total, 3/49 (6.1%), 1/44 (2.3%) and 0/49 (0.0%) patients were diagnosed with malignant cells in peritoneal fluid, pelvic lymph nodes and omentum, respectively. Positive tumour cells were not correlated with recurrence. Univariate analysis revealed that neither complete staging surgery nor individual factors were useful prognostic factors for disease-free survival. CONCLUSIONS: The staging surgery could be omitted for apparent early-stage patients affected by MOGCTs without adverse impact upon survival.
