Template-based lymphadenectomy reduces the risk of regional lymph node recurrence among patients with upper/middle ureteral cancer
Template-based lymphadenectomy reduces the risk of regional lymph node recurrence among patients with upper/middle ureteral cancer
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DOI：
10.1007/s10147-016-1024-7
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发表时间：
2017-02-01
影响因子：
3.3
通讯作者：
Tanabe, Kazunari
中科院分区：
文献类型：
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作者：
Kondo, Tsunenori;Hara, Isao;Tanabe, Kazunari
背景：我们先前的非随机前瞻性研究表明，基于模板的淋巴清扫可提高肾盆癌患者的存活率，但不能改善输尿管癌患者的存活率。然而，根据肿瘤相对于输尿管的位置不同，区域结节的位置也不同。方法1988年1月至2015年9月，我们在日本两家医疗机构为154例非转移性输尿管上皮癌患者施行了肾输尿管切除术。肿瘤部位分为输尿管下段或输尿管中、上段(髂总动脉颅穿前)。基于我们先前的作图研究，确定了合适的区域节点。淋巴清扫分为完全淋巴清扫(所有区域均已清扫)、不完全淋巴清扫(并非所有区域均已清扫)或不清扫。结果在48例输尿管中上段癌患者中，完全清扫组的无复发生存率和肿瘤特异性生存率显著高于不完全清扫组和未清扫组。然而，在56例输尿管下段癌患者中，无复发生存率和癌症特异性生存率没有差异。在输尿管中上段癌患者中，多因素分析显示基于模板的淋巴清扫与降低肿瘤特异性死亡率独立相关。结论基于模板的淋巴清扫术对治疗输尿管上、中段癌患者有疗效，但对输尿管下段癌患者没有疗效。
Background Our previous nonrandomized prospective study showed that template-based lymphadenectomy improved survival among patients with renal pelvic cancer but not among patients with ureteral cancer. However, regional node sites vary according to the tumor's location in relation to the ureter. Therefore, this retrospective study examined the therapeutic role of lymphadenectomy for ureteral cancer according to tumor location.Methods Between January 1988 and September 2015, we performed nephroureterectomy for 154 patients with non-metastatic urothelial carcinoma of the ureter at two Japanese institutions. The tumors' locations were classified as the lower ureter or the upper/middle ureter (before the cranial crossing of the common iliac artery). The appropriate regional nodes were identified based on our previous mapping study. Dissection was classified as complete lymphadenectomy (all regional sites were dissected), incomplete lymphadenectomy (not all sites were dissected), or no lymphadenectomy. We focused the analyses on patients with >= pT2 disease to clarify the effect of the lymphadenectomy.Results Among the 48 patients with upper/middle ureteral cancer, recurrence-free and cancer-specific survival were significantly higher in the complete lymphadenectomy group (vs. the incomplete or no lymphadenectomy groups). However, there were no differences in recurrence-free and cancer-specific survivals among the 56 patients with lower ureteral cancer. In the patients with upper/middle ureteral cancer, multivariate analysis revealed that template-based lymphadenectomy was independently associated with a reduced risk of cancer-specific mortality.Conclusions Template-based lymphadenectomy has a therapeutic benefit for treating patients with upper/middle ureteral cancer but not for treating patients with lower ureteral cancer.