The benefit of adding sentinel node biopsy (SNB) to extended pelvic lymph node dissection (ePLND) remains controversial. The aim of our study was to evaluate biochemical recurrence (BCR) after robot-assisted radical prostatectomy and ePLND in prostate cancer patients, stratified by the application of SNB. The results were compared with the predictions of the updated Memorial Sloan Kettering Cancer Center nomogram. Methods: Between January 2006 and November 2016, 920 patients underwent robot-assisted radical prostatectomy and ePLND with or without SNB (184 and 736 patients, respectively). BCR was defined as 2 consecutive prostate-specific antigen rises of at least 0.2 ng/mL. The Kaplan–Meier method and Cox regression analyses were used to identify predictors of BCR. Results: Median follow-up was 28 mo (interquartile range, 13–56.7 mo). The 5-y BCR-free survival rate was 80.5% and 69.9% in the ePLND+SNB and ePLND groups, respectively. At multivariate analysis, prostate-specific antigen level, primary Gleason grade greater than 3, seminal vesicle invasion, and higher number of removed and positive nodes were independent predictors of BCR in the ePLND group. In the ePLND+SNB group, only the number of positive nodes was an independent predictor of BCR. The overall accuracy of the Memorial Sloan Kettering Cancer Center nomogram was higher in the ePLND+SNB than in the ePLND group. However, the nomogram was underestimating the probability of BCR-free status in the ePLND+SNB group, whereas the ePLND group was performing as predicted. Conclusion: Adding SNB to ePLND improves BCR-free survival, although the precise explanation of this observation remains speculative. Our results should be interpreted cautiously, given the nonrandomized nature and the selection bias of the study.

将前哨淋巴结活检（SNB）添加到扩大的盆腔淋巴结清扫术（ePLND）的好处仍然存在争议。我们的研究目的是评估机器人辅助根治性前列腺切除术和ePLND在前列腺癌患者中的生化复发（BCR），按SNB的应用进行分层。将结果与更新的纪念斯隆·凯特琳癌症中心列线图的预测结果进行了比较。方法：在2006年1月至2016年11月之间，有920例患者接受了机器人辅助的根治性前列腺切除术和ePLND伴或不伴SNB（分别为184和736例）。BCR被定义为连续两次前列腺特异性抗原升高至少0.2 ng / mL。Kaplan-Meier方法和Cox回归分析用于确定BCR的预测因子。结果：中位随访时间为28 mo（四分位间距为13-56.7 mo）。ePLND + SNB和ePLND组的5-y无BCR生存率分别为80.5％和69.9％。在多变量分析中，ePLND组中前列腺特异性抗原水平，原发性格里森分级大于3，精囊浸润以及切除和阳性淋巴结增多是BCR的独立预测因子。在ePLND + SNB组中，只有阳性结节的数目是BCR的独立预测因子。ePLND + SNB中的纪念斯隆·凯特琳癌症中心列线图的整体准确性高于ePLND组。但是，列线图低估了ePLND + SNB组中无BCR状态的可能性，而ePLND组的表现与预期一致。结论：向ePLND中添加SNB可以提高无BCR生存率，尽管对此观察结果的确切解释仍是推测性的。考虑到研究的非随机性质和选择偏见，应谨慎解释我们的结果。