Kassouf Wassim, Leibovici Dan, Luongo Tony, Munsell Mark F, Vakar Funda, Dinney Colin P, Grossman H Barton, Kamat Ashish M
Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
Cancer. 2006 Oct 1;107(7):1491-5. doi: 10.1002/cncr.22139.
Previous reports have suggested that extracapsular extension (ECE) is a prognostic factor in patients with urothelial carcinoma who have positive lymph nodes at the time of radical cystectomy. In the current study, the relevance of ECE in patients treated in the contemporary era was evaluated.
A database search from 1993 to 2003 revealed 150 patients with pN+M0 disease detected after radical cystectomy; of these, 108 patients did not receive neoadjuvant chemotherapy and form the basis of the current report. Overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) data were analyzed by the Kaplan-Meier method, with log-rank tests used to evaluate associations between survival and variables studied.
Five-year OS, DSS, and RFS rates were 30.9%, 45.5%, and 29.7%, respectively. Adjuvant chemotherapy was administered to 70% of patients. On multivariate analysis, adjuvant chemotherapy was significantly associated with prolonged OS, DSS, and RFS (P </= .01). For patients overall and when stratified by pN status, the presence of ECE of lymph node metastasis was not found to be significantly associated with OS (P = .52), DSS (P = .43), or RFS (P = .83). CONCLUSIONS.: The current study suggests that ECE is not an independent prognostic factor in a contemporary series of patients with positive lymph nodes at radical cystectomy. This might be reflective of a paradigm shift that encompasses the adoption of multimodal therapy.
既往报告提示，对于根治性膀胱切除时淋巴结阳性的尿路上皮癌患者，包膜外扩展（ECE）是一个预后因素。在本研究中，评估了当代接受治疗患者中ECE的相关性。
对1993年至2003年的数据库检索显示，150例患者在根治性膀胱切除术后检测为pN+M0疾病；其中，108例患者未接受新辅助化疗，构成了本报告的基础。采用Kaplan-Meier方法分析总生存（OS）、疾病特异性生存（DSS）和无复发生存（RFS）数据，用对数秩检验评估生存与所研究变量之间的关联。
5年OS、DSS和RFS率分别为30.9%、45.5%和29.7%。70%的患者接受了辅助化疗。多因素分析显示，辅助化疗与延长OS、DSS和RFS显著相关（P≤0.01）。对于总体患者以及按pN状态分层时，未发现淋巴结转移的ECE存在与OS（P = 0.52）、DSS（P = 0.43）或RFS（P = 0.83）显著相关。结论：本研究提示，在当代根治性膀胱切除时淋巴结阳性的患者系列中，ECE不是一个独立的预后因素。这可能反映了一种范式转变，其中包括采用多模式治疗。
