Stein John P
Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90089, USA.
Curr Oncol Rep. 2007 May;9(3):213-21. doi: 10.1007/s11912-007-0024-1.
The role of regional lymph node dissection (LND) in surgical management of high-grade, invasive transitional cell carcinoma of the bladder has evolved over the past several decades. The current concepts and rationale for LND in patients undergoing radical cystectomy for bladder cancer are reviewed and discussed. Evidence suggests that a more extended LND (with cephalad extent to include at least the common iliac vessels) for lymph node-positive and -negative patients undergoing radical cystectomy for bladder cancer may provide therapeutic benefits in addition to prognostic information. Lymph node density also provides risk stratification for lymph node-positive patients and may reduce the surgical bias and extent of the LND, both of which are currently not standardized. Although the absolute limits of the LND remain to be determined, an evolving body of data supports a more extended LND at the time of cystectomy in appropriate surgical candidates.
在过去几十年中，区域淋巴结清扫术（LND）在膀胱高级别浸润性移行细胞癌手术治疗中的作用不断演变。本文回顾并讨论了膀胱癌根治性膀胱切除术患者行LND的当前概念及理论依据。有证据表明，对于接受膀胱癌根治性膀胱切除术的淋巴结阳性和阴性患者，更广泛的LND（头侧范围至少包括髂总血管）除了能提供预后信息外，还可能带来治疗益处。淋巴结密度也可为淋巴结阳性患者提供风险分层，并可能减少目前尚未标准化的LND手术偏差和范围。尽管LND的绝对界限仍有待确定，但越来越多的数据支持在合适的手术候选者行膀胱切除术时进行更广泛的LND。
