Role of lymph node dissection in the treatment of urothelial carcinoma of the upper urinary tract: Multi-institutional relapse analysis and immunohistochemical re-evaluation of negative lymph nodes
Role of lymph node dissection in the treatment of urothelial carcinoma of the upper urinary tract: Multi-institutional relapse analysis and immunohistochemical re-evaluation of negative lymph nodes
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DOI：
10.1016/j.ejso.2010.08.134
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发表时间：
2010-11-01
期刊：
影响因子：
3.8
通讯作者：
Nonomura, K.
中科院分区：
文献类型：
--
作者：
Abe, T.;Shinohara, N.;Nonomura, K.
目的：为了确定淋巴结清扫术（LND）在治疗上尿路（UUT）尿路上皮癌（UC）中的作用，患者和方法：[研究-1]一项回顾性多机构研究评估了293例接受UUT UC主要肾输尿管切除术的患者。在293名患者中，267名患者患有单纯UC，26名患者表现出其他组织学成分。关于病理性淋巴结状态，130例患者患有pN 0疾病，141例患者患有pNx疾病，22例患者患有pN+疾病。对首次复发的部位和至首次复发的时间进行了审查。复发部位分为局部复发和远处复发。分析了淋巴结状态与未来复发的关系。[研究-2]纳入了在北海道大学医院接受肾输尿管切除术的51例患者。所有患者均出现LND，所有LN在苏木精和伊红染色上均为阴性。我们重新评估存在的微转移LND标本抗细胞角蛋白免疫chemistory.Results：[研究-1]的293例患者中，76发展为疾病复发。区域淋巴结复发是最常见的部位（34例患者）。在调整肿瘤分期和肿瘤分级影响的多变量分析中，pNx（跳跃LND）不仅是局部复发的不利因素，而且也是远处复发的不利因素。[研究-2]免疫组织化学在51例患者中的7例（14%）中发现了微转移。关于生存，这7例微转移患者中有5例在最后随访时存活。结论：复发分析，跳过LND不仅是局部复发的不利因素，而且也是远处复发的不利因素。免疫组化检测到约14%的患者先前诊断为pN 0的微转移。这些发现进一步支持LND通过消除微转移而具有潜在的治疗益处。(C)2010爱思唯尔有限公司版权所有。
Aim: To determine the role of lymph node dissection (LND) in the treatment of urothelial carcinoma (UC) of the upper urinary tract (UUT).Patients and methods: [Study-1] A retrospective multi-institutional study evaluated 293 patients undergoing predominantly nephroureterectomy for UC of the UUT. Of 293 patients, 267 patients had pure UC and 26 demonstrated other histological components. Regarding the pathological node status, 130 patients had pN0 disease, 141 patients had pNx disease and 22 patients had pN+ disease. The sites of initial recurrence and time to first recurrence were reviewed. The sites of recurrence were classified as locoregional or distant recurrence. The relationship between node status and future recurrence was analyzed. [Study-2] Fifty-one patients treated by nephroureterectomy at Hokkaido University Hospital were included. All had LND and all LNs were negative on hematoxylin and eosin staining. We re-evaluated the presence of micrometastasis in LND specimens by anti-cytokeratin immunohistochemistory.Results: [Study-1] Of 293 patients, 76 developed disease relapse. Regional lymph node recurrence was the most common site (34 patients). On multivariate analyses that adjusted for the effect of tumor stage and tumor grade, pNx (skipping LND) was an adverse factor not only for locoregional recurrence, but also for distant relapse. [Study-2] Immunohistochemistry identified micrometastases in 7 (14%) of 51 patients. Regarding survival, 5 of these 7 patients with micrometastases were alive at last follow-up.Conclusions: On relapse analysis, skipping LND was an adverse factor not only for locoregional recurrence, but also for distant relapse. Immunohistochemistry detected micrometastases in about 14% of patients previously diagnosed as pN0. These findings further support a potential therapeutic benefit of LND by eliminating micrometastases. (C) 2010 Elsevier Ltd. All rights reserved.