Department of Urology, Tokyo Women's Medical University, Medical Center East, Shinjuku-ku, Tokyo, Japan.
Int J Urol. 2010 Oct;17(10):848-54. doi: 10.1111/j.1442-2042.2010.02610.x. Epub 2010 Aug 31.
The benefit of lymphadenectomy (LND) in patients with urothelial carcinoma of the upper urinary tract (UCUUT) has remained controversial. The aim of this study was to examine the influence of the LND template and the total number of lymph nodes (LN) when increasing the number of patients undergoing complete dissection of regional nodes (CompLND).
A total of 109 UCUUT patients with clinically negative nodes underwent nephroureterectomy with concomitant lymphadenectomy at our center. Patients' survival was examined according to the type of LND and the number of removed LN. Univariate analysis was performed to find the cut-off value of LN influencing survival.
Seventy-eight patients underwent CompLND. Incomplete lymphadenectomy was performed in an additional 41 patients. In the patients with pT2 or higher who were clinically negative for nodal metastasis, any cut-off value for the total number of LN removed showed no statistical significance. In contrast, CompLND had a significant impact on patient survival. The Cox proportional hazard model showed that CompLND was a significant factor after adjusting for adjuvant chemotherapy. The total number of removed LN was not significant.
In patients with muscle-invasive clinical node-negative UCUUT, the number of LN removed shows minimal influence on their survival. In contrast, the influence of the particular type of lymphadenectomy is statistically significant. These findings suggest that the extent of lymphadenectomy should be determined by the template and not by the number of removed LN.
在上尿路尿路上皮癌（UCUUT）患者中，淋巴结切除术（LND）的获益仍存在争议。本研究旨在探讨当增加完全区域淋巴结清扫术（CompLND）患者数量时，LND 模板和淋巴结总数（LN）的影响。
在我们中心，共对 109 例临床淋巴结阴性的 UCUUT 患者进行了肾输尿管切除术伴同期淋巴结切除术。根据 LND 类型和切除的 LN 数量检查患者的生存情况。采用单因素分析找到影响生存的 LN 切除数量的截止值。
78 例患者行 CompLND，另有 41 例患者行不完全淋巴结切除术。对于临床无淋巴结转移的 pT2 或更高分期的患者，任何切除的 LN 总数的截止值均无统计学意义。相比之下，CompLND 对患者生存有显著影响。Cox 比例风险模型显示，在调整辅助化疗后，CompLND 是一个显著的因素。切除的 LN 总数无显著影响。
对于肌肉浸润性临床淋巴结阴性 UCUUT 患者，切除的 LN 数量对其生存影响最小。相比之下，特定类型的淋巴结切除术的影响具有统计学意义。这些发现表明，淋巴结清扫术的范围应由模板决定，而不是由切除的 LN 数量决定。
