膀胱癌盆腔淋巴结转移：83例患者根治性膀胱切除及盆腔淋巴结清扫后的结局

Pelvic lymph node metastases from bladder cancer: outcome in 83 patients after radical cystectomy and pelvic lymphadenectomy.

作者信息

Mills R D, Turner W H, Fleischmann A, Markwalder R, Thalmann G N, Studer U E

机构信息

Department of Urology and Institutes of Pathology, University of Berne, Berne, Switzerland.

出版信息

J Urol. 2001 Jul;166(1):19-23.

PMID:11435814

Abstract

PURPOSE

We evaluate the outcome in patients with node positive bladder cancer with particular reference to the effect of individual characteristics of positive nodes on survival after meticulous pelvic lymphadenectomy at cystectomy.

MATERIALS AND METHODS

This prospective analysis contains 452 cases of bladder cancer staged preoperatively as N0M0, managed with pelvic lymphadenectomy and cystectomy between 1984 and 1997. A total of 83 (18%) patients with histologically confirmed node positive disease are included in our study.

RESULTS

The median overall survival of patients with positive nodes was 20 months. Median 5-year survival was 29%. Patients who survived were found with positive nodes at each site in the pelvis. The median survival of 57 patients with less than 5 positive nodes was 27 months, compared with 15 months for 26 with 5 nodes or more (log-rank test p = 0.0027). Median survival of 26 patients with no lymph node capsule perforation was 93 months, compared with 16 months for 57 with capsule perforation (p = 0.0004). The median survival of 18 patients with a maximum diameter of lymph node metastasis up to 0.5 cm. was 64 months, compared with 16 months for 65 with nodal metastasis greater than 0.5 cm. (p = 0.024). Contralateral positive nodes were found in 16 of 39 (41%) patients with unilateral bladder cancer.

CONCLUSIONS

Long-term survival is possible with node positive bladder cancer. Those patients with few as well as smaller and, therefore, unsuspected nodal metastases, and those without lymph node capsule perforation have the best results after removal of pelvic metastatic nodal disease. Because patients who survive may be found regardless of the site of pelvic nodal metastases, meticulous bilateral pelvic lymphadenectomy is warranted in all patients at the time of attempted curative cystectomy for bladder cancer, particularly if there is no clinical evidence of nodal involvement.

摘要

目的

我们评估淋巴结阳性膀胱癌患者的预后，特别关注阳性淋巴结的个体特征对膀胱切除术中精细盆腔淋巴结清扫术后生存的影响。

材料与方法

这项前瞻性分析纳入了1984年至1997年间术前分期为N0M0、接受盆腔淋巴结清扫术和膀胱切除术的452例膀胱癌患者。我们的研究共纳入了83例（18%）经组织学证实为淋巴结阳性疾病的患者。

结果

淋巴结阳性患者的中位总生存期为20个月。中位5年生存率为29%。存活患者的盆腔各部位均发现有阳性淋巴结。57例阳性淋巴结少于5个的患者中位生存期为27个月，而26例阳性淋巴结为5个或更多的患者中位生存期为15个月（对数秩检验p = 0.0027）。26例无淋巴结包膜穿孔的患者中位生存期为93个月，而57例有包膜穿孔的患者中位生存期为16个月（p = 0.0004）。18例淋巴结转移最大直径达0.5 cm的患者中位生存期为64个月，而65例淋巴结转移大于0.5 cm的患者中位生存期为16个月（p = 0.024）。39例单侧膀胱癌患者中有16例（41%）发现对侧阳性淋巴结。

结论

淋巴结阳性膀胱癌患者有可能获得长期生存。那些淋巴结转移少、小且因此未被怀疑的患者，以及那些没有淋巴结包膜穿孔的患者，在切除盆腔转移性淋巴结疾病后预后最佳。由于无论盆腔淋巴结转移部位如何都可能发现存活患者，因此在对膀胱癌进行根治性膀胱切除术时，所有患者都应进行精细的双侧盆腔淋巴结清扫术，特别是在没有淋巴结受累的临床证据时。