Hellenthal Nicholas J, Ramírez Michelle L, Evans Christopher P, deVere White Ralph W, Koppie Theresa M
Department of Urology, University of California, Davis Medical Center, Sacramento, California 95817, USA.
J Urol. 2009 Jun;181(6):2490-5. doi: 10.1016/j.juro.2009.02.031. Epub 2009 Apr 16.
Studies suggest that patients who undergo thorough lymphadenectomy for bladder cancer benefit from improved survival. We evaluated the incidence of and trends in lymphadenectomy in conjunction with radical cystectomy for bladder cancer.
Using the Surveillance, Epidemiology and End Results registry we identified 8,072 eligible patients with bladder cancer who underwent radical cystectomy with or without lymphadenectomy from 1988 to 2004. After stratification by age group, race, stage, grade and year of diagnosis we performed logistic and linear regression to correlate variables to the mean number of lymph nodes sampled and the likelihood of undergoing lymphadenectomy (classified as 1 or more, 5 or more and 10 or more nodes removed).
In the final cohort 1,660 patients (21%) did not have any lymph nodes sampled at radical cystectomy. This number decreased from 37% in 1988 to 16% in 2004. During this period the mean number of lymph nodes removed increased by 2.6 nodes over all definitions of lymphadenectomy and the percentage of patients undergoing any form of lymph node dissection increased by an average of 19%. Year of diagnosis was most strongly predictive of the likelihood of undergoing lymphadenectomy and most correlative with the mean number of nodes sampled.
Over time there has been improvement in terms of the performance of lymphadenectomy and node counts obtained during radical cystectomy. If these trends continue the incidence and quality of lymphadenectomy should continue to increase, ultimately to the benefit of the patients being treated.
研究表明，接受膀胱癌根治性淋巴结清扫术的患者生存率有所提高。我们评估了膀胱癌根治性膀胱切除术联合淋巴结清扫术的发生率及趋势。
利用监测、流行病学和最终结果登记处的数据，我们确定了8072例符合条件的膀胱癌患者，他们在1988年至2004年间接受了根治性膀胱切除术，无论是否进行了淋巴结清扫术。在按年龄组、种族、分期、分级和诊断年份分层后，我们进行了逻辑回归和线性回归，以将变量与采样淋巴结的平均数量以及接受淋巴结清扫术的可能性（分类为切除1个或更多、5个或更多以及10个或更多淋巴结）相关联。
在最终队列中，1660例患者（21%）在根治性膀胱切除术中未采集任何淋巴结。这一数字从1988年时的37%降至2004年时的16%。在此期间，在所有淋巴结清扫术的定义中，切除淋巴结的平均数量增加了2.6个，接受任何形式淋巴结清扫术的患者百分比平均增加了19%。诊断年份对接受淋巴结清扫术的可能性预测性最强，且与采样淋巴结的平均数量相关性最高。
随着时间推移，根治性膀胱切除术中淋巴结清扫术的实施情况和获取的淋巴结数量有所改善。如果这些趋势持续下去，淋巴结清扫术的发生率和质量应会继续提高，最终使接受治疗的患者受益。
