【摘要】 目的 腹腔镜扩大盆腔淋巴结清扫联合前列腺癌根治术（ePLND+LRP）治疗的局部晚期前列腺癌（LAPC）患者的长期随访结果报告尚不多见。本研究报告本中心246例LAPC接受e PLND+LRP治疗的10年随访结果。方法 收集2006年10月到2020年10月期间在我院接受ePLND+LRP治疗的246例LAPC患者资料，统计手术时间、失血量、住院时间和围手术期并发症、肿瘤学结果和辅助治疗效果。结果 中位年龄70（65～74）岁；中位PSA为24（10～60）ng/ml。中位手术时间、失血量和住院时间分别为217 min,170 ml,7 d。病理分期pT₂有28例（11.4%）,pT_3a 117例（47.6%）,pT_3b 92例（37.4%）,pT₄有9例（3.7%）。中位淋巴结清扫数目为21枚（13～27），中位阳性淋巴结数目为2（1～3）。淋巴结阳性和手术切缘阳性病例分别为48例（19.5%）和31例（12.6%）。38例（15.4%）出现并发症，其中17例（6.9%）为ClavienⅠ级，19例（7.7%）为ClavienⅡ，2例（0.8%）为ClavienⅢ。中位随访时间127.8个月。10年无生化复发率和无转移生存率分别为58.5%（144/246）和73.6%（181/246），肿瘤特异性生存率，总体生存率分别为91.6%以及85.3%。术后1年控尿率为96.7%。随访期内接受辅助放疗，内分泌治疗、挽救性淋巴结清扫和局部治疗分别为23例（9.3%）、219例（89.0%）、59例（24.0%）和7例（2.8%）。结论 ePLND+LRP结合辅助治疗措施治疗LAPC的10年肿瘤根治效果满意。更多还原

【Abstract】 Objective The long-term follow-up results of patients with locally advanced prostate cancer（LAPC） treated with laparoscopic extensive pelvic lymph node dissection combined with radical prostatectomy（ePLND+LRP） are still rare. This study reports 246 LAPC patients treated with ePLND+LRP from 2006 to 2020 in the Third Affiliated Hospital of Sun Yat-sen University. Methods From October 2006 to October 2020, 246 LAPC patients with ePLND+LRP were enrolled in this study.The operation time, blood loss, duration of hospital stay and complications, oncology results, and adjuvant treatments occurred within 30 days after surgery were collected. Results The median age was 70（65-74）years; the median PSA was 24（10-60） ng/ml. The median operation time, blood loss, and hospital stay were 217 minutes, 170 ml, and 7 days, respectively. In pathological staging, there were 28 cases（11.4%） in pT₂, 117 cases（47.6%） in pT_3a, 92 cases（37.4%） in pT_3b, and 9 cases（3.7%） in pT₄. The median number of lymph nodes dissected was 21（13-27）, and the median number of positive lymph nodes was 2（1-3）. 48（19.5%） and 31（12.6%） patients had positive lymph nodes and positive surgical margins. Thirtyeight（15.4%） patients experienced complications, of which 17 cases（6.9%） were classified as Clavien Ⅰ, 19 cases（7.7%） were classified as Clavien Ⅱ, and 2 cases（0.8%） were classified as Clavien Ⅲ. The median follow-up time was 127.8 months, during the follow-up period, 23（9.3%）, 219（89.0%）, 59（24.0%）, and 7（2.8%） patients received adjuvant radiotherapy（RT）, hormone therapy（HT）, and salvage lymph node dissection（s LND）, salvage local treatment. The 10-year BCR-free survival and metastasis-free survival（MFS） rates were 58.5%（144/246） and 73.6%（181/246）, respectively. Cancer-specific survival（CSS） and overall survival（OS） were 91.6% and 85.3%, respectively. The rate of urinary control at one year after operation was 96.7%. Conclusion The e PLND+LRP treatment of LAPC has fewer complications and a good tumor control effect. It is safe and effective as the initial treatment of LAPC.更多还原