Leissner J, Hohenfellner R, Thüroff J W, Wolf H K
Departments of Urology and Pathology, Johannes Gutenberg University, Mainz, Germany.
BJU Int. 2000 May;85(7):817-23. doi: 10.1046/j.1464-410x.2000.00614.x.
To determine the need to standardize the number and location of lymph nodes to be removed during radical cystectomy in patients with invasive bladder carcinoma.
The pelvic lymph nodes from 447 patients (mean age 62.8 years) who underwent radical cystectomy between 1986 and 1997 were evaluated. The number of lymph nodes was correlated with the depth of invasion of the primary tumour (pT), occurrence of nodal metastases, clinical outcome, the operating surgeons and the pathologists dissecting the nodes.
The clinical follow-up was available for 302 patients (mean follow-up 38.7 months). The mean (range) number of lymph nodes removed was 14.7 (1-46). The number of lymph nodes removed varied significantly among different surgeons but not among pathologists. In pT3 and pT4 tumours, a more extended lymphadenectomy (>/= 16 lymph nodes) correlated with a higher percentage of patients with documented nodal metastases. There was a significant correlation between the number of lymph nodes removed and the tumour-free 5-year survival in patients with pT1, pT2 or pT3 tumours, and in patients with 1-5 positive lymph nodes (P < 0.01).
Extensive lymphadenectomy significantly improves the prognosis of patients with invasive bladder cancer and represents a potentially curative procedure in patients with nodal metastases, including micrometastases that may escape detection during routine histopathological evaluation. The results indicate the need for a standardized lymph node dissection.
确定对浸润性膀胱癌患者行根治性膀胱切除术时需切除的淋巴结数量及位置进行标准化的必要性。
对1986年至1997年间接受根治性膀胱切除术的447例患者（平均年龄62.8岁）的盆腔淋巴结进行评估。淋巴结数量与原发肿瘤的浸润深度（pT）、淋巴结转移的发生情况、临床结局、手术医生以及解剖淋巴结的病理学家相关。
302例患者有临床随访资料（平均随访38.7个月）。切除淋巴结的平均数量（范围）为14.7个（1 - 46个）。不同手术医生切除的淋巴结数量差异显著，而不同病理学家之间则无差异。在pT3和pT4肿瘤中，更广泛的淋巴结清扫术（≥16个淋巴结）与有记录的淋巴结转移患者的更高比例相关。在pT1、pT2或pT3肿瘤患者以及有1 - 5个阳性淋巴结的患者中，切除的淋巴结数量与无瘤5年生存率之间存在显著相关性（P < 0.01）。
广泛的淋巴结清扫术显著改善浸润性膀胱癌患者的预后，对于有淋巴结转移的患者，包括在常规组织病理学评估中可能漏检的微转移患者，是一种潜在的治愈性手术。结果表明需要进行标准化的淋巴结清扫。
