Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Eur J Surg Oncol. 2010 Nov;36(11):1085-91. doi: 10.1016/j.ejso.2010.08.134. Epub 2010 Sep 15.
To determine the role of lymph node dissection (LND) in the treatment of urothelial carcinoma (UC) of the upper urinary tract (UUT).
[Study-1] A retrospective multi-institutional study evaluated 293 patients undergoing predominantly nephroureterectomy for UC of the UUT. Of 293 patients, 267 patients had pure UC and 26 demonstrated other histological components. Regarding the pathological node status, 130 patients had pN0 disease, 141 patients had pNx disease and 22 patients had pN+ disease. The sites of initial recurrence and time to first recurrence were reviewed. The sites of recurrence were classified as locoregional or distant recurrence. The relationship between node status and future recurrence was analyzed. [Study-2] Fifty-one patients treated by nephroureterectomy at Hokkaido University Hospital were included. All had LND and all LNs were negative on hematoxylin and eosin staining. We re-evaluated the presence of micrometastasis in LND specimens by anti-cytokeratin immunohistochemistory.
[Study-1] Of 293 patients, 76 developed disease relapse. Regional lymph node recurrence was the most common site (34 patients). On multivariate analyses that adjusted for the effect of tumor stage and tumor grade, pNx (skipping LND) was an adverse factor not only for locoregional recurrence, but also for distant relapse. [Study-2] Immunohistochemistry identified micrometastases in 7 (14%) of 51 patients. Regarding survival, 5 of these 7 patients with micrometastases were alive at last follow-up.
On relapse analysis, skipping LND was an adverse factor not only for locoregional recurrence, but also for distant relapse. Immunohistochemistry detected micrometastases in about 14% of patients previously diagnosed as pN0. These findings further support a potential therapeutic benefit of LND by eliminating micrometastases.
确定淋巴结清扫术（LND）在治疗上尿路上皮癌（UC）的上尿路（UUT）的作用。
[研究 1]回顾性多机构研究评估了 293 例主要行肾输尿管切除术治疗 UUT 尿路上皮癌的患者。在 293 例患者中，267 例患者为单纯 UC，26 例患者有其他组织学成分。关于病理淋巴结状态，130 例患者为 pN0 疾病，141 例患者为 pNx 疾病，22 例患者为 pN+疾病。回顾了初始复发部位和首次复发时间。将复发部位分为局部或远处复发。分析了淋巴结状态与未来复发的关系。[研究 2]北海道大学医院行肾输尿管切除术的 51 例患者被纳入本研究。所有患者均行 LND，所有 LNs 在苏木精和伊红染色下均为阴性。我们通过抗细胞角蛋白免疫组织化学重新评估 LND 标本中是否存在微转移。
[研究 1]在 293 例患者中，76 例发生疾病复发。局部淋巴结复发是最常见的部位（34 例）。在调整肿瘤分期和肿瘤分级影响的多变量分析中，pNx（跳过 LND）不仅是局部复发的不良因素，也是远处复发的不良因素。[研究 2]免疫组化在 51 例患者中的 7 例（14%）中发现了微转移。关于生存，7 例有微转移的患者中有 5 例在最后一次随访时仍存活。
在复发分析中，跳过 LND 不仅是局部复发的不良因素，也是远处复发的不良因素。免疫组化在以前诊断为 pN0 的患者中约 14%检测到微转移。这些发现进一步支持 LND 通过消除微转移具有潜在的治疗益处。
