Pelvic lymph node metastases from bladder cancer: Outcome in 83 patients after radical cystectomy and pelvic lymphadenectomy
Pelvic lymph node metastases from bladder cancer: Outcome in 83 patients after radical cystectomy and pelvic lymphadenectomy
复制标题
DOI：
10.1016/s0022-5347(05)66067-3
复制
发表时间：
2001-07-01
影响因子：
6.6
通讯作者：
Studer, UE
中科院分区：
文献类型：
--
作者：
Mills, RD;Turner, WH;Studer, UE
目的：我们评估淋巴结阳性膀胱癌患者的结果，特别是在膀胱切除术中进行细致的盆腔淋巴结切除术后，阳性淋巴结的个体特征对生存的影响。材料和方法：这项前瞻性分析包含 452 例术前分期为 N0M0 的膀胱癌病例，在 1984 年至 1997 年间接受盆腔淋巴结切除术和膀胱切除术治疗。总共 83 名（18%）经组织学证实淋巴结阳性疾病的患者被纳入研究。纳入我们的研究。结果：淋巴结阳性患者的中位总生存期为 20 个月。中位 5 年生存率为 29%。幸存的患者在骨盆的每个部位都发现了阳性淋巴结。 57 名少于 5 个阳性淋巴结的患者的中位生存期为 27 个月，而 26 名有 5 个或更多淋巴结的患者的中位生存期为 15 个月（对数秩检验 p = 0.0027）。 26 名无淋巴结膜穿孔患者的中位生存期为 93 个月，而 57 名淋巴结膜穿孔患者的中位生存期为 16 个月 (p = 0.0004)。淋巴结转移最大直径达0.5 cm的18例患者的中位生存期。 65 例淋巴结转移大于 0.5 厘米的患者为 64 个月，而 65 例患者为 16 个月。 （p = 0.024）。 39 名单侧膀胱癌患者中，有 16 名 (41%) 发现对侧阳性淋巴结。结论：淋巴结阳性膀胱癌有可能长期生存。那些数量较少且较小且因此未被怀疑的淋巴结转移的患者，以及那些没有淋巴结包膜穿孔的患者在切除盆腔转移性淋巴结疾病后可以获得最佳结果。由于无论盆腔淋巴结转移的部位如何，都可能发现存活的患者，因此在尝试对膀胱癌进行根治性膀胱切除术时，所有患者都需要进行细致的双侧盆腔淋巴结切除术，特别是在没有淋巴结受累的临床证据的情况下。
Purpose: We evaluate the outcome in patients with node positive bladder cancer with particular reference to the effect of individual characteristics of positive nodes on survival after meticulous pelvic lymphadenectomy at cystectomy.Materials and Methods: This prospective analysis contains 452 cases of bladder cancer staged preoperatively as N0M0, managed with pelvic lymphadenectomy and cystectomy between 1984 and 1997. A total of 83 (18%) patients with histologically confirmed node positive disease are included in our study.Results: The median overall survival of patients with positive nodes was 20 months. Median 5-year survival was 29%. Patients who survived were found with positive nodes at each site in the pelvis. The median survival of 57 patients with less than 5 positive nodes was 27 months, compared with 15 months for 26 with 5 nodes or more (log-rank test p = 0.0027). Median survival of 26 patients with no lymph node capsule perforation was 93 months, compared with 16 months for 57 with capsule perforation (p = 0.0004). The median survival of 18 patients with a maximum diameter of lymph node metastasis up to 0.5 cm. was 64 months, compared with 16 months for 65 with nodal metastasis greater than 0.5 cm. (p = 0.024). Contralateral positive nodes were found in 16 of 39 (41%) patients with unilateral bladder cancer.Conclusions: Long-term survival is possible with node positive bladder cancer. Those patients with few as well as smaller and, therefore, unsuspected nodal metastases, and those without lymph node capsule perforation have the best results after removal of pelvic metastatic nodal disease. Because patients who survive may be found regardless of the site of pelvic nodal metastases, meticulous bilateral pelvic lymphadenectomy is warranted in all patients at the time of attempted curative cystectomy for bladder cancer, particularly if there is no clinical evidence of nodal involvement.