Lymph Node Yield at Radical Cystectomy Predicts Mortality in Node-negative and not Node-positive Patients
Lymph Node Yield at Radical Cystectomy Predicts Mortality in Node-negative and not Node-positive Patients
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DOI：
10.1016/j.urology.2012.03.070
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发表时间：
2012-09-01
期刊：
影响因子：
2.1
通讯作者：
Cookson, Michael S.
中科院分区：
文献类型：
--
作者：
Morgan, Todd M.;Barocas, Daniel A.;Cookson, Michael S.
目的通过在一个大规模人群队列中识别和控制关键混杂变量，更好地确定淋巴结计数与接受根治性膀胱切除术的膀胱癌患者生存率之间的关系。相当大的争议仍然关于节点计数和生存之间的相关性，大多数以前的分析没有考虑到患者和供应商factors.METHODS的监测，流行病学和最终结果（SEER）-医疗保险链接的数据库被用来确定从1992年至2006年接受根治性膀胱癌的尿路上皮膀胱癌患者。根据有无淋巴结转移将患者分为2组，我们进行了考克斯回归分析，以评估淋巴结计数与生存率之间的关系。协变量包括年龄、Charlson合并症指数、分期、分级、淋巴结密度、阳性淋巴结数量、尿流改道、化疗、手术年、输血和外科医生数量。在淋巴结阴性患者中，与淋巴结计数最高的三分位数相比，淋巴结计数低的个体的总生存期（OS）和疾病特异性生存期（DSS）显著更差。在淋巴结阳性患者中，淋巴结计数不是OS或DSS的独立预测因子。结论在无淋巴结转移的患者中，根治性膀胱癌时淋巴结计数与OS和DSS均相关。然而，在淋巴结阳性疾病患者中，淋巴结计数不是生存的独立预测因子，这表明它可能是这些个体中其他患者和提供者因素的代理。泌尿学80：632-640，2012年。(c)2012 Elsevier Inc. All rights reserved.
OBJECTIVE To better define the relationship between lymph node count and survival in patients undergoing radical cystectomy for bladder cancer by identifying and controlling for key confounding variables in a large population-based cohort. Considerable controversy remains regarding the correlation between node count and survival, and most prior analyses have not accounted for both patient and provider factors.METHODS The Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database was used to identify patients with urothelial bladder carcinoma who underwent radical cystectomy from 1992 to 2006. Patients were divided into 2 cohorts based on the presence or absence of nodal metastases, and we performed Cox regression analyses to evaluate the association between node count and survival. Covariates included age, Charlson comorbidity index, stage, grade, lymph node density, number of positive nodes, urinary diversion, chemotherapy, year of surgery, transfusion, and surgeon volume.RESULTS The cohort consisted of 2391 node-negative and 779 node-positive patients. In node-negative patients, individuals with low node counts had significantly worse overall survival ( OS) and disease-specific survival (DSS) compared to the highest node count tertile. In node-positive patients, node count was not an independent predictor of OS or DSS.CONCLUSION Lymph node count at radical cystectomy is associated with both OS and DSS in patients without nodal metastases. However, in patients with node-positive disease, node count is not an independent predictor of survival suggesting that it is likely a proxy for other patient and provider factors in these individuals. UROLOGY 80: 632-640, 2012. (c) 2012 Elsevier Inc. All rights reserved.