Impacto bioquímico de la omisión de la linfadenectomía en cáncer de próstata: validación de las tablas de Partin
DOI:
https://doi.org/10.48193/revistamexicanadeurologa.v82i6.881Palabras clave:
Recidiva bioquímica, linfadenectomía, cáncer de próstata, prostatectomía radicalResumen
Introducción: La linfadenectomía es el método de elección en la valoración linfática en pacientes diagnosticados con cáncer de próstata. El primer reto es conocer la probabilidad de afectación con nomogramas, el más usado es el de Partin. De acuerdo con estos nomogramas, aquellos pacientes con afectación mayor al 2% tienen indicación de linfadenectomía durante la prostatectomía con finalidad terapéutica y pronóstica. La recidiva bioquímica se define como un nivel sérico de antígeno prostático específico superior a 0.2 ng/ml confirmado al menos 4 semanas después de la prostatectomía.
Material y métodos: Se realizó un estudio retrospectivo descriptivo y se revisaron los registros de 150 casos de prostatectomía radical consecutiva realizados entre 2007 y 2019. Un total de 109 pacientes se incluyeron. Se calculó por nomograma de Partin la probabilidad de invasión a nódulos linfáticos, y se seleccionaron todos aquellos con un porcentaje de afectación mayor o igual al 2%, Se dividieron en dos grupos: con linfadenectomía pélvica (grupo PLND) sin linfadenectomía pélvica (no-PLND). Se llevó a cabo un análisis de Shapiro-Wilks para comprobar la normalidad de los datos. La p fue <0.01 en ambos casos por lo que se procedió a llevar a cabo una prueba de Wilcoxon, usando el programa Statistica 8.0.
Resultados: Mediante una correlación de Spearman y con una p>0.01, se comprobó que no existió una relación entre el cálculo mayor al 2% de involucro de nódulos linfáticos por nomograma de Partin y la recidiva bioquímica temprana.
Conclusión: En nuestro estudio la linfadenectomía no modificó el riesgo de progresión bioquímica, por lo que el efecto terapéutico beneficioso de la linfadenectomía sistemática podría ser muy limitado. El omitir la linfadenectomía pélvica durante la prostatectomía con un porcentaje mayor o igual al 2% en nuestro análisis no tuvo relación directa con la recidiva bioquímica. El uso de otros nomogramas ajustados a nuestra población puede marcar diferencia en estos resultados.
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