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Salvagelymphadenektomie beim Rezidiv eines Prostatakarzinoms

Eine Übersicht

Salvage lymphadenectomy in patients with prostate cancer recurrence

A review

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Zusammenfassung

Hintergrund

Die salvageextendierte pelvine Lymphknotendissektion (Salvage-ePLND, „extended pelvic lymph node dissection“) bei Patienten mit einem biochemischen Rezidiv des Prostatakarzinoms (PCa) ist eine alternative Therapieoption gegenüber der herkömmlichen Androgendeprivationstherapie (ADT) und/oder Chemotherapie. Limitierende Faktoren für die Verbreitung der Salvage-ePLND sind die geringe Anzahl operierter Patienten, die unzureichende Genauigkeit der bisherigen bildgebenden Methoden zur Diagnostik eines Lymphknotenrezidivs und das Fehlen prospektiver Daten. Ziel der Arbeit ist es, eine Übersicht von deutschen und europäischen Daten und Studien zum Thema Salvage-ePLND zu erstellen und weitere Perspektiven zu diskutieren.

Material und Methoden

Wir analysierten die bis Oktober 2014 verfügbaren Studien in Medline mit den Schlüsselwörtern „salvage lymph node dissection prostate cancer“.

Ergebnisse

Wir haben die bis Oktober 2014 verfügbaren Studien in Medline mit den Schlüsselwörtern „salvage lymph node dissection prostate cancer“ analysiert. Für den Zeitraum seit 1984 wurden 51 Publikationen (Stand Oktober 2014) mit den angegebenen Suchkriterien gefunden. Davon beschäftigen sich 10 Studien mit den Ergebnissen und der Ergebnisanalyse von Patienten, die sich einer Salvage-ePLND unterzogen. 6 dieser 10 Studien stammen aus deutschen Kliniken. Außerdem wurden 2 Fallberichte (einer davon aus Deutschland) und 3 Reviews (bis dato keine aus Deutschland) gefunden.

Diskussion

Die bis dato vorhandenen Daten zum Thema Salvage-ePLND zeigen einen Mangel an evidenzbasierter Aussagekraft. Bis jetzt wurde keine prospektive Studie und nur eine multizentrische Studie durchgeführt. Die monozentrischen retrospektiven Recherchen zeigten jedoch vielversprechende Ergebnisse. Die Salvage-ePLND führt zu einer biochemischen Remission, zur klinischen Rezidivfreiheit und häufig zum erneuten Ansprechen auf ADT bei Patienten mit kastrationsresistentem PCa. Prospektive multizentrische Studien sollten in Deutschland (Land mit den meisten Studien zu diesem Thema) initiiert und durchgeführt werden. Die Patientenselektion sollte diskutiert werden, um klare Indikationen für eine Salvage-ePLND stellen zu können.

Abstract

Background

Salvage extended pelvic lymph node dissection (salvage ePLND) in patients with prostate cancer (PCa) biochemical recurrence is an alternative to the commonly used androgen deprivation therapy (ADT) and/or chemotherapy. Small patient number, insufficient accuracy of contemporary imaging methods for lymph node relapse diagnostics, and the lack of prospective data present limiting factors for a wider application of salvage ePLND. The purpose of this publication is to review German and European data and studies on the subject of salvage ePLND and to discuss future perspectives.

Materials and methods

We analyzed available studies up to October 2014 from Medline with the keywords “salvage lymph node dissection prostate cancer”.

Results

A total of 51 publications since 1984 (up to October 2014) meeting the search criteria were found. Ten of these were studies that analyzed the results of salvage ePLND. Of these 10 studies, 6 originated from German clinics. Furthermore, among these 51 publications, there were 2 clinical case reports (1 from Germany) and 3 reviews (none from Germany).

Conclusions

The available data show insufficient evidence-based validity. There have been no prospective studies and just one multicenter study. However, single-center retrospective studies have shown promising results. Salvage ePLND leads to biochemical remission, freedom from clinical recurrence, and probably also to renewed response to ADT in patients with castration-resistant PCa. Multicenter prospective studies should be conducted in Germany (where most of the available studies have been performed). The selection of patients should be analyzed in order to identify clear selection criteria for salvage ePLND.

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Abb. 1

Abbreviations

ADT:

Androgendeprivationstherapie

ASR:

altersstandardisierte Raten nach dem Europastandard pro 100.000 Einwohner

BCR:

biochemisches Rezidiv

CRPC:

kastrationsresistentes Prostatakarzinom

ePLND:

extendierte pelvine Lymphknotendissektion

GÜ:

Gesamtüberleben

KR:

klinisches Rezidiv

KRÜ:

klinisches rezidivfreies Überleben

KSÜ:

krebsspezifisches Überleben

LK:

Lymphknoten

LND:

Lymphknotendissektion

MRL:

MR-Lymphoangiographie

NPW:

negativer prädiktiver Wert

PCa:

Prostatakarzinom

PPW:

positiver prädiktiver Wert

RARP:

roboterassistierte RRPx

RRPx:

radikale Prostatektomie

RT:

Radiotherapie

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Einhaltung ethischer Richtlinien

Interessenkonflikt. D.K. Osmonov, A.V. Aksenov, C.A. Jilg, W. Schultze-Seeman, C.M. Naumann, M.F. Hamann, K. Bothe und K.-P. Jünemann geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Urologie und Kinderurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller Straße 3, Haus 18, 24105, Kiel, Deutschland

    D.K. Osmonov,  A.V. Aksenov, C.M. Naumann, M.F. Hamann, K. Bothe & K.-P. Jünemann

  2. Klinik für Urologie, Universitätsklinik Freiburg, Freiburg, Deutschland

    C.A. Jilg & W. Schultze-Seeman

Authors
  1. D.K. Osmonov
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  2. A.V. Aksenov
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  3. C.A. Jilg
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  4. W. Schultze-Seeman
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  5. C.M. Naumann
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  6. M.F. Hamann
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  7. K. Bothe
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  8. K.-P. Jünemann
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Correspondence to A.V. Aksenov.

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Osmonov, D., Aksenov, A., Jilg, C. et al. Salvagelymphadenektomie beim Rezidiv eines Prostatakarzinoms. Urologe 55, 208–217 (2016). https://doi.org/10.1007/s00120-015-4000-3

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