Table 2 Summary of several studies comparing oncological outcomes of PLND in RP
Study&Type | Study period | Cohort | Cohort size | Risk category | Pathological stage | Gleason score | ISUP grade | Positive surgical margin | PLND template | Removed LNs (median) | Positive LNs rate | Outcome measure | Follow-up duration (median) | Oncological outcomes |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Fergany et al. [32] Retrospective | 1986- 1999 | RRP noPLND | 203 | NA |  ≥ pT3b(1.0%) |  ≤ 6(61%)  ≥ 7(39%) | NA | NA | / | / | / | Biochemical failure, Biochemical relapse-free survival(BCRFS) | 38mo | Biochemical failure: 7.0%, n = 40(33 in PLND group + 7 in noPLND group) 4-yr BCRFS: 97%(noPLND) vs 91%(PLND) (p = 0.16) PLND or noPLND was not independent predictor of BCR |
RRP PLND | 372 | NA |  ≥ pT3b(4.0%) |  ≤ 6(60%)  ≥ 7(40%) | NA | NA | NA | NA | 1.6% | |||||
Furubayashi et al. [33] Retrospective | 1998- 2013 | RP sPLND | 247 | NA |  ≤ pT2(59.5%)  ≥ pT3(40.5%) |  ≤ 7(76.5%)  > 8(23.5%) | NA | 23.5% | Obturator Internal iliac | 13 | NA | PSA failure | 53.7mo | PSA recurrence: sPLND(17.8%) vs ePLND + mePLND(13.9%)(p = 0.36) Multivariate analysis: The range of PLND(standard vs.extended) is significantly associated with PSA failure(HR 2.099, [95%CI 1.140–4.099], p = 0.0164) |
RP ePLND | 78 | NA |  ≤ pT2(55.1%)  ≥ pT3(44.9%) |  ≤ 7(70.5%)  > 8(29.5%) | NA | 17.9% | Obturator Internal iliac External iliac | 19 | NA | |||||
RP mePLND | 23 | NA |  ≤ pT2(60.9%)  ≥ pT3(39.1%) |  ≤ 7(73.9%)  > 8(26.1%) | NA | 13.1% | Obturator Internal iliac External iliac Common iliac | 19 | NA | |||||
Wettstein et al. [30] Retrospective | 2006- 2016 | RP ePLND | 368 | NA |  ≥ pT3(39.1%) | NA | 1(4.9%) 2(43.5%) 3(26.9%) 4(7.1%) 5(17.7%) | 35.6% | Obturator Internal iliac External iliac Common iliac | NA | 10.3% | Time to biochemical recurrence(BCR) or secondary therapy | 3.5 yr | BCR or secondary therapy: ePLND 22.6% vs nePLND 22.7% Survival analysis: ePLND(weighted HR: 0.75[95%CI 0.56–0.99], p = 0.044) Casual mediation analysis: protective direct effect of 0.69(0.63–0.75) |
RP nePLND | 640 | NA |  ≥ pT3(55.0%) | NA | 1(7.3%) 2(52.7%) 3(25.9%) 4(6.6%) 5(7.5%) | 25.9% | NA | NA | 5.2% | 2.2 yr | ||||
Iwamura et al. [34] Retrospective | 2010- 2020 | RP lPLND | 283 | High(100%) | pT0(10.2%) pT2(59.4%) pT3(30.4%) | No residual tumor(10.2%) 6(0.4%) 7(4.3%) 8(6.7%) 9–10(78.4%) | NA | 6.0% | Obturator | 4 | 0.8% | BCRFS | 77mo | 3 yr BCRFS: 89.1%(lPLND) vs 86.0%(nonPLND), p = 0.516 5 yr BCRFS: 84.1%(lPLND) vs 82.0%(nonPLND), p = 0.516 COX regression analysis: BCRFS is not significantly diferrence between two groups(HR 1.44, p = 0.469) |
RP nonPLND | 233 | pT0(11.2%) pT2(62.7%) pT3(26.2%) | No residual tumor(11.2%) 6(0.9%) 7(27.0%) 8(0.9%) 9–10(60.1%) | NA | 11.6% | / | / | / | 34mo | |||||
Touijer et al. [29] RCT | 2011- 2017 | RP ePLND | 740 | NA |  ≥ pT3(49%) | NA | 1(7.3%) 2(53%) 3(24%) 4(16%) Unknown | NA | Obturator Internal iliac External iliac | 14 | 14.0% | BCR | 3.1 yr | BCR rate: No difference (HR 1.04, [95%CI 0.93–1.15], p = 0.5 for lPLND as the reference group) |
RP lPLND | 700 | NA |  ≥ pT3(54%) | NA | 1(5.9%) 2(58%) 3(23%) 4(12%) Unknown | NA | External iliac | 12 | 12.0% | |||||
Namiki et al. [35] Retrospective | 2012- 2021 | RARP nonPLND | 605 | Low(16.0%) Intermediate(70.4%) High(13.6%) | pT2(22.0%) pT3(78.0%) | NA | 1(9.1%) 2(51.0%) 3(27.6%) 4(8.3%) 5(4.0%) | 20.7% | / | / | / | BCRFS | 17.2mo | 3 yr BCRFS: nonPLND 93.7% vs PLND 91.5%(p = 0.855) BCRFS: No difference between PLND and nonPLND in the all-risk group |
RARP PLND | 605 | Low(13.9%) Intermediate(70.2%) High(15.9%) | pT2(20.7%) pT3(79.3%) | NA | 1(10.2%) 2(50.5%) 3(27.6%) 4(7.1%) 5(4.6%) | 19.8% | Limited (Obturator) Extended(NA) | 5 | 1.0% | 24.7mo | ||||
Lestingi et al. [27] Prospective | 2012- 2016 | RP ePLND | 150 | Intermediate(62%) High(38%) | pT0(0) pT2(41%) pT3a(45%) pT3b(14%) pT4(0.7%) | 6(2.7%) 7(85%) 8(1.3%) 9–10(11%) | NA | 44.0% | Obturator Internal iliac External iliac Common iliac Presacral | 17 | 17.0% | BCRFS MFS(Metastasis-free survival) CSS(Cancer-specific survival) | 53.9mo | Median BCRFS: not reached(ePLND) vs 61.4mo(lPLND)(HR 0.91, [95%CI 0.63–1.32], p = 0.6) Median MFS: not reached in either group(HR 0.57,[ 95%CI 0.17–1.8], p = 0.3) CSS: NA |
RP lPLND | 150 | Intermediate(63%) High(37%) | pT0(0.7%) pT2(38%) pT3a(43%) pT3b(18%) pT4(0.7%) | 6(4%) 7(80%) 8(0.7%) 9–10(15%) | NA | 37.0% | Obturator | 3 | 3.4% |