Publikationsserver der Universitätsbibliothek Marburg

Titel:Der Lymphknotenstatus beim Prostatakarzinom - Korrelationen mit präoperativen Parametern und prognostischen Endpunkten unter besonderer Berücksichtigung der Lymphknotendichte
Autor:Hoffmann, Jonas
Weitere Beteiligte: Olbert, Peter (Dr.)
Veröffentlicht:2011
URI:https://archiv.ub.uni-marburg.de/diss/z2012/0023
DOI: https://doi.org/10.17192/z2012.0023
URN: urn:nbn:de:hebis:04-z2012-00231
DDC:610 Medizin
Titel (trans.):Lymph node metastasis in prostate cancer - correlations with pre-operative parameters and prognostic end-points with special regard to lymph node density
Publikationsdatum:2012-02-16
Lizenz:https://rightsstatements.org/vocab/InC-NC/1.0/

Dokument

Schlagwörter:
Lymph node density, Lymphknoten, Prostatakrebs, Lymphknotendichte

Zusammenfassung:
Das Prostatakarzinom ist die vierthäufigste Krebserkrankung des Mannes weltweit. In der männlichen Bevölkerung Westeuropas und Nordamerikas hat es die höchste Inzidenz und die zweithöchste Letalität aller malignen Tumore. Standardtherapie bei lokal begrenztem Prostatakarzinom ist die radikale Prostatektomie mit pelviner Lymphadenektomie, so dass eine mögliche Lymphknoteninfiltration detektiert werden kann. Lymphknotenmetastasen sind anerkanntermaßen ein schlechtes prognostisches Zeichen. Bislang wurde unterschieden zwischen N0- und N1-Status, diese Einteilung scheint durch die Nichtberücksichtigung von ergänzender Information zur differenzierten Betrachtung der Prognose jedoch zu einfach zu sein. Trotz großer Fortschritte, die in den letzten Jahren in der Diagnostik und Therapie erreicht wurden, bleiben viele Fragen offen. Diese betreffen unter anderem die Bedeutung von verschiedenen Ausprägungen der Lymphknotenmetastasierung zur Prognosestellung. Ziel der vorliegenden Arbeit war, einerseits zu zeigen, inwiefern präoperativ erhobene Parameter eine Lymphknotenmetastasierung vorhersagen können und andererseits, welche einzelnen Faktoren bei positivem Lymphknotenstatus die prognostischen Endpunkte beeinflussen. 913 Patienten des Universitätsklinikums Marburg wurden retrospektiv untersucht, 99 Patienten zeigten histologisch gesicherte Lymphknotenmetastasen (10,84%). Der mittlere Nachbeobachtungszeitraum betrug 51 Monate nach radikaler Prostatektomie. Zur Erfassung der Patientendaten und zur statistischen Analyse wurde eine Datenbank mit der Software SPSS erstellt. Die Möglichkeit der Vorhersage einer Lymphknotenmetastasierung durch prätherapeutisch erhobene Daten zu klinischem Stadium, PSA-Wert und Gleason-Score konnte für jeden Wert einzeln als auch in der multivariaten Analyse mit hochsignifikanten Werten bestätigt werden (p<0,001). In einem zweiten Teil wurde der pN-Status, sowie differenzierte Information wie extranodales Tumorwachstum, Lymphknotendichte und absolute Anzahl der entnommenen Lymphknoten mit den prognostischen Parametern Gesamtüberleben, rezidivfreies Überleben, rezidivfreies Intervall und karzinomspezifische Mortalität korreliert. Hierzu wurden Kreuztabellen, statistische Tests und Kaplan-Meier-Kurven erstellt. Für das Gesamtüberleben konnten hinsichtlich des Lymphknotenstatus keine Abhängigkeiten gezeigt werden. Tendenzen konnten durch die Zusammenschau mit Komorbiditäten erkannt werden. Hingegen konnte nachgewiesen werden, dass der Lymphknotenstatus signifikant mit der Rezidivhäufigkeit korrelierte (p=0,046). Die rezidivfreie Überlebenszeit korrelierte bei hier untersuchtem Patientenkollektiv und vorhandenem Nachbeobachtungszeitraum mit keinem der untersuchten Parameter signifikant. Bedingt durch die langsam progrediente Natur des Prostatakarzinoms war in der vorliegenden Arbeit wohl vor allem der Nachbeobachtungszeitraum zu kurz und die einzelnen Patientengruppen zu klein, um für diese Fragestellungen signifikante Ergebnisse zu erhalten. So sind spezifisch an ihrem Prostatakarzinom nur zwei der 913 Patienten gestorben, diese waren beide lymphknotenpositiv. Die Kontinenzzufriedenheit hing von der Operationstechnik ab, mit dem Lymphknotenstatus beziehungsweise einer adjuvanten Therapie war der Nachweis einer Korrelation nicht zu führen. Zusammenfassend konnte in dieser Arbeit die Korrelation von präoperativen Parametern mit einem positiven Lymphknotenstatus eindeutig bestätigt werden. Für die untersuchten prognostischen Parameter waren einige Tendenzen zu erkennen, die in künftigen prospektiven Studien mit sehr großen Patientenzahlen und langen Nachbeobachtungszeiträumen genauer analysiert werden sollten. Die für die vorliegende Arbeit erstellte Datenbank mit dem Patientengut des Universitätsklinikums Marburg wird auch in Zukunft gepflegt und um alle hier behandelten Prostatakarzinompatienten ergänzt werden, so dass an diesem Standort künftig weitere retrospektive Studien mit längeren Nachbeobachtungszeiträumen und größeren Patientenkollektiven möglich sein werden.

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