저위험도 전립선암 환자의 치료 편집하기 (부분)

== 근거표 ==
{| class="wikitable"
!KQ5
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!Reference
|1. Briganti A, Larcher A, Abdollah F, et al. Updated nomogram predicting lymph node invasion in patients with prostate cancer undergoingextended pelvic lymph node dissection: the essential importance of percentage of positive cores. Eur Urol 2012;61(3):480-7.
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!Study type
|Retrospective study
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!Patients
|588 patients with clinically localised PCa 
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!Purpose of Study
|Update a nomogram predicting the presence of LNI in patients treated with ePLND at the time of radical prostatectomy (RP).
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!Study Results
|The mean number of lymph nodes removed and examined was 20.8 (median: 19; range: 10-52). LNI was found in 49 of 588 patients (8.3%). All preoperative PCa characteristics differed significantly between LNI-positive and LNI-negative patients (all p<0.001). In UVA predictive accuracy analyses, percentage of positive cores was the most accurate predictor of LNI (AUC: 79.5%). At MVA, clinical stage, primary biopsy Gleason grade, and percentage of positive cores were independent predictors of LNI (all p≤0.006). The updated nomogram demonstrated a bootstrap-corrected PA of 87.6%. Using a 5% nomogram cut-off, 385 of 588 patients (65.5%) would be spared ePLND. and LNI would be missed in only 6 patients (1.5%). The sensitivity, specificity, and negative predictive value associated with the 5% cut-off were 87.8%, 70.3%, and 98.4%, respectively. The relatively low number of patients included as well as the lack of an external validation represent the main limitations of our study.
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!Level of Study
|2b
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!Reference
|2. Cagiannos I, Karakiewicz P, Eastham JA, Ohori M, Rabbani F, Gerigk C, et al. A preoperative nomogram identifying decreased risk of positive pelvic lymph nodes in patients with prostate cancer. J Urol 2003;170:1798-803.
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!Study type
|Retrospective study
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!Patients
|7,014 patients treated with radical prostatectomy at 6 institutions between 1985 and 2000. 
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!Purpose of Study
|To develope a preoperative nomogram for prediction of lymph node metastases in patients with clinically localized prostate cancer.
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!Study Results
|Overall 5,510 patients with complete clinical and pathological information were included in the study. Lymph nodes metastases were present in 206 patients (3.7%). Pretreatment PSA, biopsy Gleason sum, clinical stage and institution represented predictors of lymph node status (p<0.001). Bootstrap corrected predictive accuracy of the 3-variable nomogram (clinical stage, Gleason sum and PSA) was 0.76. Inclusion of a fourth variable, which accounts for institutional differences in lymph node metastases, yielded an area under the receiver operating characteristics curve of 0.78. The negative predictive value of our nomograms was 0.99 when they predicted 3% or less chance of positive lymph nodes.
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!Level of Study
|3
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!Reference
|3. Ledezma RA, Negron E, Razmaria AA, et al. Robotic-assisted pelvic lymph node dissection for prostate cancer: frequency of nodal metastases and oncological outcomes. World J Urol 2015;33:1689-94.
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!Study type
|Retrospective study
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!Patients
|1,740 patients treated with robot-assisted radical prostatectomy between 1985 and 2000.
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!Purpose of Study
|To observe biochemical recurrence according to nodal status. To investigate independent predictors for biochemical recurrence. 
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!Study Results
|One hundred and eight patients (6%) with positive LNs were identified. The median number of LNs removed was 17 (IQR 11-24), and median follow-up was 26 months (IQR 14-43). Ninety-one (84%) patients did not receive adjuvant ADT of whom 60% had BCR with a median time to recurrence of 8 months. The 1- and 3-year BCR-free probability was 42 and 28%, respectively. Patients with ≤2 LN+ had significantly better biochemicalfree estimated probability compared to those with >2 LN+ (p=0.002). The total number of LN+ (HR=1.1; 95% CI 1.01-1.2, p=0.04) and Gleason 8-10 (HR=1.96; 95% CI 1.1-3.4, p=0.02) were predictors of BCR on multivariate analysis.
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!Level of Study
|3
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!Reference
|4. Muck A, Langesberg C, Mugler M, et al. Clinical outcomes of patients with lymph nodepositive prostate cancer following radical prostatectomy and extended sentinel lymph node dissection. Urol Int 2015;94(3):296-306.
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!Study type
|Retrospective study
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!Patients
|From August 2002 until February 2011, a total of 819 patients with clinically localized PCa, confirmed by biopsy, were treated with radical retropubic prostatectomy (RRP) plus extended sentinel lymph node dissection (eSLND).
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!Purpose of Study
|To evaluate the clinical outcome after eSLND and RRP in patients with clinically localized prostate cancer.
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!Study Results
|The mean follow-up was 5.3 years. Lymph node (LN) metastases occurred in 140 patients. We removed an average of 10.9 LNs via eSLND from patients with pN1 PCa. Postoperatively, 121 pN1 patients temporarily received adjuvant androgen deprivation therapy. The mean survival periods for RFS, RFS after secondary treatment, CSS, and OS were 4.7, 7.0, 8.8, and 8.1 years, respectively. The cancer-specific death rate of the 140 pN1 patients was 13.6%. RFS, CSS, and OS were significantly correlated with pathological margin status, LN density, the total diameter of evident metastases, and membership in the subgroup ‘micrometastases only’.
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!Level of Study
|3
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