Critical analysis and validation of lymph node density as prognostic variable in urothelial carcinoma of bladder
Critical analysis and validation of lymph node density as prognostic variable in urothelial carcinoma of bladder
复制标题
DOI：
10.1016/j.urolonc.2011.02.011
复制
发表时间：
2013-05-01
影响因子：
2.7
通讯作者：
Skinner, Eila C.
中科院分区：
文献类型：
--
作者：
Kassouf, Wassim;Svatek, Robert S.;Skinner, Eila C.
目的：为了验证淋巴结密度（LND）的预后相关性，并确定其最佳分界点在一个大型的国际多中心系列的患者接受根治性化疗（RC）治疗浸润性膀胱癌。方法：从1993年至2005年，4,430例膀胱癌患者接受RC没有新辅助化疗进行了审查;结果：患者的中位年龄为67岁，存活者的中位随访时间为33个月。总体而言，5年DSS估计值为36%。中位切除淋巴结数为18（IQR，11-32），中位阳性淋巴结数为2（IQR，1-5），中位LND为14.3%（IQR，6.67-33.3%）。LND作为连续变量，在经历更广泛PLND的患者中是DSS的更强的预后因素（P < 0.001）。随着LND临界点的增加，LND与DSS负相关的HR逐渐增加。将LND分为五分位揭示了基于LND 41%的强烈的三级风险分布，累积5年DSS分别为47%，36%和21%（P < 0.001）。当患者进行分层的辅助化疗，LND仍然是独立的预后在接受辅助化疗的患者，以及那些谁没有.Conclusion：淋巴结密度是预后在膀胱癌患者谁经历了更广泛的PLND和仍然预后，即使辅助化疗是使用。LND的预后价值最好表现为风险和LND的连续性。
Objective: To validate the prognostic relevance of lymph node density (LND) and identify its optimal cut-points in a large international multicenter series of patients treated with radical cystectomy (RC) for invasive bladder cancer.Methods: From 1993 to 2005, 4,430 bladder cancer patients who underwent RC without neoadjuvant chemotherapy were reviewed; of these, 1,038 were pN+M0 disease and form the basis of this report.Results: Median age of patients was 67 years with median follow-up in survivors of 33 months. Overall, 5-year DSS estimate was 36%. Median number of lymph nodes removed was 18 (IQR, 11-32), median number of positive lymph nodes was 2 (IQR, 1-5), and median LND was 14.3% (IQR, 6.67-33.3%). LND as continuous variable was a stronger prognostic factor for DSS in patients that underwent a more extensive PLND (P < 0.001). HR for inverse association of LND with DSS increased incrementally with increasing LND cut-points. Categorizing LND into quintiles revealed strong tertiary distribution of risk based on LND 41% with cumulative 5-year DSS of 47%, 36%, and 21%, respectively (P < 0.001). When patients were stratified by adjuvant chemotherapy, LND remains independently prognostic in patients who received adjuvant chemotherapy as well as those who did not.Conclusion: Lymph node density is prognostic in bladder cancer patients who undergo a more extensive PLND and remains prognostic even when adjuvant chemotherapy is used. Prognostic value of LND is best represented as a continuum of risk and LND