Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Urology. 2010 Jun;75(6):1431-5. doi: 10.1016/j.urology.2009.11.076. Epub 2010 Mar 17.
To evaluate the prognostic significance of the total number of lymph nodes obtained at postchemotherapy retroperitoneal lymph node dissection (PC-RPLND). After the multidisciplinary management of metastatic germ cell tumor, approximately 10%-15% of patients with the histologic finding of fibrosis or teratoma will suffer disease recurrence.
Between 1989 and 2006, a total of 628 patients underwent PC-RPLND and were found to have either fibrosis or teratoma. After Institutional Review Board approval, complete clinical and pathologic data were obtained from our prospective testis cancer surgical database. A Cox proportional hazards regression model was constructed to evaluate the association of the total number of lymph nodes obtained at PC-RPLND on disease recurrence.
On pathologic evaluation, 248 (57%) patients had fibrosis and 184 (43%) patients had teratoma. The median number of lymph nodes resected was 25 (interquartile range, 15-37). On multivariable analysis, increasing postchemotherapy nodal size and decreasing lymph node counts were significant predictors of disease recurrence (P=.01, .04, respectively). For patients with 10 nodes removed, the predicted 2-year relapse free probability was 90%, compared with 97% when 50 nodes were removed.
Our data suggest that the total number of lymph nodes removed and analyzed is an independent predictor of disease recurrence after PC-RPLND. This has implications both for the urologist to assure completeness of resection and for the pathologist to meticulously assess the pathologic specimens.
评估化疗后腹膜后淋巴结清扫术（PC-RPLND）中获取的淋巴结总数的预后意义。在转移性生殖细胞肿瘤的多学科管理之后，大约 10%-15%的组织学发现纤维化或畸胎瘤的患者会出现疾病复发。
1989 年至 2006 年期间，共有 628 例患者接受了 PC-RPLND，结果发现有纤维化或畸胎瘤。在机构审查委员会批准后，我们从前瞻性睾丸癌手术数据库中获得了完整的临床和病理数据。构建 Cox 比例风险回归模型来评估 PC-RPLND 中获取的淋巴结总数与疾病复发的关联。
在病理评估中，248 例（57%）患者有纤维化，184 例（43%）患者有畸胎瘤。切除的淋巴结中位数为 25（四分位距，15-37）。多变量分析显示，化疗后淋巴结大小增加和淋巴结计数减少是疾病复发的显著预测因素（P=.01，.04）。对于切除 10 个淋巴结的患者，预测的 2 年无复发生存率为 90%，而切除 50 个淋巴结时为 97%。
我们的数据表明，PC-RPLND 后切除和分析的淋巴结总数是疾病复发的独立预测因素。这对泌尿科医生确保切除的完整性和病理学家仔细评估病理标本都有影响。
