Comparative study of lymph node dissection, and oncological outcomes of laparoscopic and open radical nephroureterectomy for patients with urothelial carcinoma of the upper urinary tract undergoing regional lymph node dissection.
Comparative study of lymph node dissection, and oncological outcomes of laparoscopic and open radical nephroureterectomy for patients with urothelial carcinoma of the upper urinary tract undergoing regional lymph node dissection.
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DOI：
10.1093/jjco/hyy128
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发表时间：
2018-11-01
影响因子：
2.4
通讯作者：
Shinohara N
中科院分区：
文献类型：
--
作者：
Abe T;Kondo T;Harabayashi T;Takada N;Matsumoto R;Osawa T;Minami K;Nagamori S;Maruyama S;Murai S;Tanabe K;Shinohara N
我们揭示了采用腹腔镜行淋巴清扫术(LND)的可行性，以及与开腹肾输尿管切除术(LND)进行区域性淋巴清扫术时，腹腔镜肾输尿管切除术的肿瘤学结果相当。评价淋巴结清扫量作为判断淋巴结清扫范围的替代指标，比较标准化淋巴清扫术患者在腹腔镜下根治性肾输尿管切除术(LRNU)和开腹根治性肾输尿管切除术(ORNU)的生存结果。回顾分析214例cTanyN0M0根治性淋巴结清扫术患者的临床资料。生存分析采用Kaplan-Meier方法和Cox风险模型，包括无复发生存率(RFS)、肿瘤特异性生存率(CS)和总生存率(OS)。114例患者接受了LRNU，100例患者接受了ORNU。在PT分期、PN分期和肿瘤分级方面，LRNU组无显著差异，但输尿管下段肿瘤在LRNU组中更为常见。两组淋巴结清除量差异无统计学意义[LRNU：12(中位数)，ORNU：11.5，P=0.3852]。19例(8.9%)经病理证实有淋巴结转移。5年生存率分别为71.7%和74%(P=0.7829)，总有效率分别为77.8%和80%(P=0.8441)，总有效率分别为72.8%和75.9%(P=0.3456)。在对PT3/4患者(n=83)的子分析中，尽管接受ORNU的患者的Kaplan-Meier生存曲线略好，但两组之间的RFS、CS或OS没有显著差异。在多变量模型中，LRNU与较差的RFS、CSS或OS没有显著相关性。我们的数据支持采用腹腔镜方法进行淋巴结清扫术的可行性，并且在区域淋巴结清扫术中，LRNU与ORNU的肿瘤学结果相当。然而，LRNU应该在仔细选择晚期疾病的患者之后进行。
We revealed the feasibility of lymph node dissection (LND) with a laparoscopic approach and the equivalent oncological outcome of laparoscopic nephroureterectomy compared with open nephroureterectomy when regional LND is performed. To assess the number of lymph nodes removed as a surrogate marker of the extent of lymph node dissection, and compare survival outcomes between laparoscopic radical nephroureterectomy (LRNU) and open radical nephroureterectomy (ORNU) in patients undergoing standardized lymph node dissection. We retrospectively analyzed the data of 214 cTanyN0M0 patients undergoing radical NU with regional lymph node dissection according to the tumor location. The Kaplan–Meier method and Cox hazards model were utilized for survival analyses, including recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS). A total of 114 patients underwent LRNU and 100 underwent ORNU. There was no significant difference in the pT stage, pN stage, or tumor grade, but distal ureteral tumors were more frequent in the LRNU group. The number of lymph nodes removed did not differ between the two groups [LRNU: 12 (median), ORNU: 11.5, P = 0.3852]. Lymph node metastasis was pathologically identified in 19 patients (8.9%). The 5-year RFS (ORNU: 71.7%, LRNU: 74%, P = 0.7829), CSS (77.8 and, 80%, P = 0.8441) and OS (72.8, and 75.9%, P = 0.3456) did not differ between the two groups. In the sub-analysis of pT3/4 patients (n = 83), there were no significant differences in RFS, CSS, or OS between the two groups, although Kaplan–Meier survival curves were slightly better for those receiving ORNU. In the multivariate model, LRNU was not significantly correlated with a poorer RFS, CSS or OS. Our data support the feasibility of lymph node dissection with a laparoscopic approach and the equivalent oncological outcome of LRNU compared with ORNU when regional lymph node dissection is performed. However, LRNU should be performed after careful patient selection for advanced disease.
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影响因子：
23.4
作者：
Roupret, Morgan;Babjuk, Marko;Shariat, Shahrokh F.
通讯作者：
Shariat, Shahrokh F.
影响因子：
3.3
作者：
Kondo, Tsunenori;Hara, Isao;Tanabe, Kazunari
通讯作者：
Tanabe, Kazunari
影响因子：
23.4
作者：
Simone, Giuseppe;Papalia, Rocco;Gallucci, Michele
通讯作者：
Gallucci, Michele
影响因子：
23.4
作者：
Nguyen DP;Al Hussein Al Awamlh B;Wu X;O'Malley P;Inoyatov IM;Ayangbesan A;Faltas BM;Christos PJ;Scherr DS
通讯作者：
Scherr DS
影响因子：
3.4
作者：
Xylinas, Evanguelos;Colin, Pierre;Roupret, Morgan
通讯作者：
Roupret, Morgan