Up to 50% of patients recur after salvage radiation therapy (sRT) for prostate-specific antigen (PSA) rise following radical prostatectomy (RP). Notably, the importance of lymph node dissection (LND) at the time of RP with regard to recurrence risk following sRT has not been previously determined. Therefore, we evaluated the association between nodal yield at RP and recurrence after sRT. We performed a multi-institutional review of men with a rising PSA after RP treated with sRT. Clinicopathologic variables were abstracted, and the associations between lymph node yield and biochemical (BCR) as well as clinical recurrence (CR) after sRT were assessed using multivariable Cox proportional hazards regression models. In total, 728 patients were identified; of these, 221 and 116 were diagnosed with BCR and CR, respectively, during a median follow-up of 8.4 (interquartile range: 4.2–11.2) yr. On multivariable analysis, the risk of BCR after sRT was inversely associated with the number of nodes resected at RP (hazards ratio [HR]: 0.98; 95% confidence interval [CI]: 0.96–0.99; p = 0.049). Increased extent of dissection was also independently associated with a decreased risk of CR after sRT (HR: 0.97; 95%CI: 0.94–0.99; p = 0.042). These data support the importance of an extensive LND at surgery and may be used in prognosis assessment when sRT is being considered.

Patient summary

We found that patients who had increased number of lymph nodes resected at surgery had improved outcomes after the receipt of salvage radiation therapy. These findings support the use of the extended lymph node dissection at initial surgery and should serve to improve counseling among patients who require salvage radiation therapy.

中文翻译：

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根治性前列腺切除术中更广泛的淋巴结清扫术与挽救性放射疗法改善手术后前列腺特异性抗原升高的结果相关：长期，多机构分析

根治性前列腺切除术（RP）后，针对前列腺特异性抗原（PSA）的挽救性放射治疗（sRT）上升后，多达50％的患者复发。值得注意的是，关于sRT术后复发风险，RP时淋巴结清扫（LND）的重要性尚未得到确定。因此，我们评估了RP的淋巴结产量与sRT后复发之间的关联。我们对经sRT治疗的RP后PSA升高的男性患者进行了多机构审查。提取临床病理变量，并使用多变量Cox比例风险回归模型评估sRT后淋巴结产量与生化（BCR）以及临床复发（CR）之间的关联。总共确定了728例患者。其中，分别有221和116位患者被诊断为BCR和CR，在8.4年（四分位间距：4.2-11.2）年的中位随访期间。在多变量分析中，sRT后发生BCR的风险与在RP切除的结节数目成反比（风险比[HR]：0.98； 95％置信区间[CI]：0.96-0.99；p  = 0.049）。sRT后清扫范围的增加还与CR风险的降低独立相关（HR：0.97； 95％CI：0.94-0.99；P  = 0.042）。这些数据支持在手术中广泛使用LND的重要性，并且在考虑sRT时可用于预后评估。

病人总结

我们发现，在接受挽救性放疗后，手术切除的淋巴结数目增加的患者的结局有所改善。这些发现支持在初次手术时使用扩大的淋巴结清扫术，应有助于改善需要抢救性放射治疗的患者的咨询。