Department of Urology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany.
Am J Med Sci. 2010 Apr;339(4):341-4. doi: 10.1097/MAJ.0b013e3181d2c590.
In this study, we aimed to determine those clinical and pathologic features that are associated with pelvic lymph node metastasis in patients with transitional cell cancer of the bladder. Unlike previous studies, we particularly focused on intravesical tumor location.
We included 173 patients who underwent radical cystectomy and bilateral pelvic lymphadenectomy for muscle-invasive or high-risk superficial bladder cancer. Fifty patients (28.9%) presented with lymph node metastases. Tumor-related and personal characteristics were analyzed.
Lymph node positive disease occurred in association with an increasing pathologic tumor stage (P < 10(-6)) and with a decreasing differentiation status (P = 0.008). The rate of pelvic lymph node metastasis differed in primary tumors growing on different intravesical locations. Cancers located exclusively on the lateral bladder walls (P < 10(-5)) and tumors involving the lateral walls (P = 0.042) were highly correlated with lymph node positive disease. Posterior wall tumors were least associated with lymph node metastases compared with other tumor locations (P = 0.015). Focal tumor growths located on the lateral bladder wall and an increasing pathologic tumor stage and decreasing differentiation-status were identified as independent risk factors for the pelvic lymph node status.
For the first time we present the association of intravesical tumor location and the rate of lymph node metastasis in transitional cell cancer of the bladder. Our findings may ultimately contribute to a more individualized patient management.
本研究旨在确定膀胱癌患者中与盆腔淋巴结转移相关的临床和病理特征。与以往的研究不同，我们特别关注膀胱内肿瘤的位置。
我们纳入了 173 例接受根治性膀胱切除术和双侧盆腔淋巴结清扫术的肌层浸润性或高危表浅膀胱癌患者。50 例（28.9%）患者出现淋巴结转移。分析了肿瘤相关和个人特征。
淋巴结阳性疾病与病理肿瘤分期增加（P < 10(-6))和分化程度降低（P = 0.008）有关。盆腔淋巴结转移的发生率在不同膀胱内位置的原发性肿瘤中有所不同。仅位于膀胱侧壁的肿瘤（P < 10(-5))和累及侧壁的肿瘤（P = 0.042)与淋巴结阳性疾病高度相关。与其他肿瘤位置相比，后壁肿瘤与淋巴结转移的相关性最低（P = 0.015)。位于膀胱侧壁的局灶性肿瘤生长、病理肿瘤分期增加和分化程度降低被确定为盆腔淋巴结状态的独立危险因素。
我们首次提出了膀胱癌膀胱内肿瘤位置与淋巴结转移率之间的关联。我们的研究结果最终可能有助于实现更个体化的患者管理。
