Extented Versus Standard Pelvic Lymph Node Dissection For Patients With Clinically Localized Prostate Cancer In Radical Prostatectomy On Efficacy?Safety And Oncological Outcomes:A Systematic Review And Meta-analysis

Objective:By comparing the efficacy?safety and oncological outcomes of extented and standard pelvic lymph node dissection(PLND)in radical prostatectomy(RP),explore the clinical value of extented lymphadenectomy for patients with clinically localized prostate adenocarcinoma in radical prostatectomy.Methods:We collected literatures associated with all controlled trials to performed a systematic review of radical prostatectomy with extented PLND(ePLND),and RP with standard(sPLND)or limited PLND(lPLND)in patients with clinically localized prostate cancer using the PubMed,Embase,Cochrane Library,CNKI,Wanfang Data Knowledge Service Platform,CBM and using the terms “prostatectomy”,“lymph node dissection”,“prostate cancer”,and“extent/extented/standard/standardized/limit/limite d”.Related articles were published from updated to January 1,2018 and no languag e restrictions were applied.The limited template was included in the sPLND.Results:Fourteen studies with a total of 12,148 patients were included.Compared with sPLND,ePLND significantly improved lymph node yield(LNY)(WMD=9.72,95%CI:6.81~12.63,p<0.00001)and the detection of more lymph node positivity of meta stasis(LN+)(RR=2.89,95%CI:2.16~3.86,p<0.00001).ePLND increased the complicationrate,but the differences were not statistically significant(RR=1.39,95%CI:0.95~2.05,p=0.09).The ePLND group have significantly lower biochemical recurrence(BCR)(R R=0.69,95%CI:0.52~0.91,p=0.01)and higher biochemical-free survival(HR=0.59,95%CI:0.56-0.63,p<0.00001).Meanwhile,the biochemical-free survival was analyzed by extracting survival data from the published Kaplan-Meier(KM)curves.In addition,we obtained summarized survival curves by reconstructing the KM data.Conlucsion:ePLND shows benefits associated with increased LNY,LN+ and safety.In between these 2 starkly contrasting scenarios,ePLND could be an oncological benefit with decreased BCR and increased biochemical-free survival.Additional highquality,well-disigned randomized controlled trials with long-term follow-up results are required to define the optimal procedure for patients with clinically localized prostate cancer.