Prognosis of radical prostatectomy combined with pelvic lymph node dissection in patients with intermediate- and high-risk prostate cancer: a systematic review and single-arm meta-analysis.

[BACKGROUND] The efficacy of pelvic lymph node dissection (PLND) in enhancing the prognosis of patients with intermediate- and high-risk prostate cancer (PCa) has been a subject of ongoing debate. It is noteworthy that a majority of existing studies on this topic are retrospective and have shorter follow-up durations. This meta-analysis is therefore purposed to assess the prognosis of intermediate to high-risk PCa patients who have undergone a combination of radical prostatectomy (RP) and PLND.

[METHODS] This study systematically searched multiple databases, including but not limited to PubMed and Web of Science, and conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant single-arm meta-analysis. Study quality was assessed using both the Cochrane risk of bias tool and ROBINS-I tool.

[RESULTS] In our analysis, we included 18 studies that involved 3881 patients. The meta-analysis indicated that the biochemical recurrence-free survival (BRFS) rates at 2-year, 4-year, and 5-year points for intermediate- and high-risk PCa patients who received RP in conjunction with extended pelvic lymph node dissection (EPLND) were 85% (95% CI 81-88%; I = 65%, P = 0.020), 77% (95% CI 73-82%; I = 77%, P = 0.005), and 72% (95% CI 66-78%; I = 74%, P = 0.020), respectively. Biochemical persistence (BCP) was recorded at 14% (95% CI 11-16%; I = 15%, P = 0.310). We observed adverse event (AE) rates for Clavien grades 1-2 to be 14% (95% CI 7-22%; I = 96%, p < 0.00001), while Clavien grades ≥ 3 had an AE rate of 4% (95% CI 3-6%; I = 22%, p = 0.240). The incidence of lymphoceles was found to be at 3% (95% CI 2-4%; I = 37%, p = 0.130).

[CONCLUSION] In patients presenting with intermediate- to high-risk PCa, the combined therapeutic approach of RP with EPLND demonstrates a significant association with favorable oncological outcomes. While the intervention may be accompanied by certain AEs, it is clinically relevant to note that the majority of these complications are classified as Clavien grades 1-2. However, this conclusion still requires more high-quality research to be verified.