Capitanio Umberto, Suardi Nazareno, Shariat Shahrokh F, Lotan Yair, Palapattu Ganesh S, Bastian Patrick J, Gupta Amit, Vazina Amnon, Schoenberg Mark, Lerner Seth P, Sagalowsky Arthur I, Karakiewicz Pierre I
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.
BJU Int. 2009 May;103(10):1359-62. doi: 10.1111/j.1464-410X.2008.08212.x. Epub 2008 Dec 8.
To identify the likelihood of finding one or more positive lymph nodes (LNs) according to the number of LNs removed at radical cystectomy (RC), as the number of LNs removed affects disease progression and survival after RC.
Between 1984 and 2003, 731 assessable patients had RC and bilateral pelvic lymphadenectomy at three different institutions. ROC curve coordinates were used to determine the probability of identifying one or more positive LNs according to the total number of removed LNs.
Of the 731 patients, 174 (23.8%) had LNs metastases. The mean (median, range) number of LNs removed was 18.7 (17, 1-80). The ROC coordinate-based plots of the number of removed LNs and the probability of finding one or more LNs metastases indicated that removing 45 LNs yielded a 90% probability. Conversely, removing either 15 or 25 LNs indicated, respectively, 50% and 75% probability of detecting one or more LNs metastases.
These data indicate that removing 25 LNs might represent the lowest threshold for the extent of lymphadenectomy at RC. Our findings confirm the importance of an extended lymph node dissection.
根据根治性膀胱切除术（RC）时切除的淋巴结（LN）数量，确定发现一个或多个阳性LN的可能性，因为切除的LN数量会影响RC后的疾病进展和生存。
1984年至2003年间，731例可评估患者在三个不同机构接受了RC及双侧盆腔淋巴结清扫术。采用ROC曲线坐标，根据切除的LN总数确定发现一个或多个阳性LN的概率。
731例患者中，174例（23.8%）发生LN转移。切除的LN平均（中位数，范围）数量为18.7（17，1 - 80）。基于ROC坐标绘制的切除LN数量与发现一个或多个LN转移概率的图表明，切除45个LN时发现转移的概率为90%。相反，切除15个或25个LN时，发现一个或多个LN转移的概率分别为50%和75%。
这些数据表明，切除25个LN可能是RC时淋巴结清扫范围的最低阈值。我们的研究结果证实了扩大淋巴结清扫的重要性。
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