Bolenz Christian, Shariat Shahrokh F, Fernández Mario I, Margulis Vitaly, Lotan Yair, Karakiewicz Pierre, Remzi Mesut, Kikuchi Eiji, Zigeuner Richard, Weizer Alon, Montorsi Francesco, Bensalah Karim, Wood Christopher G, Roscigno Marco, Langner Cord, Koppie Theresa M, Raman Jay D, Mikami Shuji, Michel Maurice Stephan, Ströbel Philipp
Mannheim Medical Center, University of Heidelberg, Germany.
BJU Int. 2009 Feb;103(3):302-6. doi: 10.1111/j.1464-410X.2008.07988.x. Epub 2008 Oct 16.
To determine the risk factors associated with clinical outcome in patients with lymph node (LN)-positive urothelial carcinoma of the upper urinary tract (UTUC) treated with radical nephroureterectomy (RNU) and lymphadenectomy, focusing on the concept of LN density (LND).
Patients undergoing RNU with regional lymphadenectomy were identified through multi-institutional databases. All pathology slides were re-evaluated by genitourinary pathologists unaware of the clinical data. The exposure variable used was LND (continuously coded and that of all possible thresholds) with recurrence-free and disease-specific survival (DSS) serving as the outcome measures.
Of 432 patients undergoing RNU with lymphadenectomy, 135 (31%) had LN metastases. Within a median follow-up of 4.1 years, 90 of the 135 patients with LN metastases (68%) had disease recurrence and 76 (58%) died from UTUC. The mean (sem) 5-year recurrence-free and DSS probabilities were 27 (4)% and 33 (5)%, respectively. The median (range) LND was 50 (3-100)%. The most informative threshold for LND in relation to outcome was 30%. In multivariable analyses that adjusted for the effects of tumour stage and grade, patients with a LND of > or =30% were at greater risk of both cancer recurrence, with 5-year rates of 25 (5)% vs 38 (8)% (hazard ratio 1.8, P = 0.021) and mortality, with 5-year rates of 30 (6)% vs 48 (9)% (1.7, P = 0.032) compared to those with a LND of <30%. Our results are primarily limited by a lack of standardization in the lymphadenectomy template.
We evaluated the concept of LND for the first time in UTUC. LND provides additional prognostic information in patients with node-positive disease after RNU. The use of LND in clinical trials might provide an additional insight into the value of LN dissection in patients undergoing RNU.
确定接受根治性肾输尿管切除术（RNU）及淋巴结清扫术的淋巴结（LN）阳性上尿路尿路上皮癌（UTUC）患者临床结局的相关危险因素，重点关注LN密度（LND）这一概念。
通过多机构数据库识别接受RNU及区域淋巴结清扫术的患者。所有病理切片由不了解临床数据的泌尿生殖病理学家重新评估。所使用的暴露变量为LND（连续编码以及所有可能的阈值），无复发生存期和疾病特异性生存期（DSS）作为结局指标。
在432例接受RNU及淋巴结清扫术的患者中，135例（31%）有LN转移。在中位随访4.1年期间，135例有LN转移的患者中有90例（68%）疾病复发，76例（58%）死于UTUC。5年无复发生存率和DSS概率的均值（标准误）分别为27（4）%和33（5）%。LND的中位数（范围）为50（3 - 100）%。与结局相关的LND最具信息量的阈值为30%。在对肿瘤分期和分级的影响进行校正的多变量分析中，LND≥30%的患者癌症复发风险更高，5年复发率分别为25（5）%和38（8）%（风险比1.8，P = 0.021），死亡风险也更高，5年死亡率分别为30（6）%和48（9）%（1.7，P = 0.032），而LND<30%的患者则较低。我们的结果主要受淋巴结清扫模板缺乏标准化的限制。
我们首次在UTUC中评估了LND这一概念。LND为RNU后淋巴结阳性疾病患者提供了额外的预后信息。在临床试验中使用LND可能会为接受RNU患者的淋巴结清扫价值提供更多见解。
