Critical Evaluation of the American Joint Committee on Cancer TNM Nodal Staging System in Patients with Lymph Node-Positive Disease after Radical Cystectomy
Critical Evaluation of the American Joint Committee on Cancer TNM Nodal Staging System in Patients with Lymph Node-Positive Disease after Radical Cystectomy
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DOI：
10.1016/j.eururo.2012.04.050
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发表时间：
2012-10-01
期刊：
影响因子：
23.4
通讯作者：
Skinner, Eila C.
中科院分区：
文献类型：
--
作者：
Bruins, H. Max;Dorin, Ryan P.;Skinner, Eila C.
背景资料：目前第7版的美国癌症联合委员会膀胱癌TNM分期系统基于LN位置而不是LN大小对淋巴结（LN）阳性疾病进行分期。此外，髂总淋巴结现在被认为是区域性淋巴结。这些变化是否改善了淋巴结阳性patients.Objective：探讨TNM淋巴结分期系统第7版是否提供了比第6版更好的上级诊断，设计，设置和参与者：2002年至2008年的患者，包括根治性膀胱切除术后合并扩大或超扩大LN夹层淋巴结转移。使用两种TNM分期系统对患者进行分期。结果测量和统计分析：Kaplan-Meier曲线用于估计总生存期（OS）和无复发生存期（RFS）。对数秩检验和考克斯比例风险回归模型被用来测试与OS和RFS.Results和局限性的病理变量的关联：包括146例LN转移，其中131例患者进行了超扩展LN剥离和15例患者进行了扩展LN剥离。尽管在第7版TNM中，许多患者从N2类转移到N3类，但在两个版本中，RFS在淋巴结亚组中没有显著差异。主动脉分叉处或以上的LN转移与RFS降低无关（p = 0.67）。在多变量分析中，存在膀胱外疾病（风险比[HR]：2.84; p = 0.002）、无辅助化疗（HR：0.32; p < 0.0001）和6个以上阳性LN（HR：2.72; p = 0.007）与RFS降低相关。这是一项回顾性研究，固有的limitations.Conclusions：LN或以上的主动脉分叉应被视为区域LN。无论是第6或第7 TNM分期系统作为一个预后工具。需要开发一种更好的LN阳性膀胱癌分期系统。(C)2012年欧洲泌尿外科协会。由Elsevier B出版。V.保留所有权利。
Background: The current 7th edition of the American Joint Committee on Cancer TNM staging system for bladder cancer stages lymph node (LN)-positive disease based on LN location rather than LN size. In addition, common iliac LNs are now considered regional LNs. Whether these changes improve prognostication for node-positive patients, however, remains unclear.Objective: To investigate whether the 7th edition of the TNM nodal staging system provides superior prognostication compared with the 6th edition.Design, setting, and participants: Patients between 2002 and 2008 with LN metastases after radical cystectomy combined with extended or superextended LN dissection were included. Patients were staged using both TNM staging systems. Median follow-up was 54 mo.Outcome measurements and statistical analysis: Kaplan-Meier curves were used to estimate overall survival (OS) and recurrence-free survival (RFS). Log-rank tests and Cox proportional hazard regression models were used to test associations of pathologic variables with OS and RFS.Results and limitations: Included were 146 patients with LN metastases of whom 131 patients underwent superextended LN dissection and 15 patients underwent extended LN dissection. Although in the 7th TNM edition many patients moved from the N2 category to the N3 category, RFS did not significantly differ within the nodal subgroups in either editions. LN metastases at or above the aortic bifurcation were not associated with decreased RFS (p = 0.67). On multivariable analysis, the presence of extravesical disease (hazard ratio [HR]: 2.84; p = 0.002), absence of adjuvant chemotherapy (HR: 0.32; p < 0.0001), and more than six positive LNs (HR: 2.72; p = 0.007) were associated with decreased RFS. This was a retrospective study with inherent limitations.Conclusions: LNs at or above the aortic bifurcation should be considered regional LNs. Neither the 6th nor the 7th TNM staging system performed well as a prognostic tool. A better staging system for LN-positive bladder cancer needs to be developed. (C) 2012 European Association of Urology. Published by Elsevier B. V. All rights reserved.