Department of Pathology, University of Bern, Bern, Switzerland.
Histopathology. 2011 Mar;58(4):571-8. doi: 10.1111/j.1365-2559.2011.03778.x. Epub 2011 Mar 14.
To evaluate risk factors in lymph node-positive bladder cancer.
Lymph node-positive bladder cancer patients (n=162), preoperatively staged N0M0, underwent cystectomy and standardized extended lymphadenectomy. Five-year overall survival of the cohort was 33%. In univariate analysis, tumour stage (P<0.006), extracapsular extension of lymph node metastases (P<0.001), total diameter of metastases (P<0.04) and lymph node stage (P<0.03) were significantly correlated with overall survival (OS), disease-specific survival (DSS) and recurrence-free survival (RFS). On multivariate analysis, only extracapsular extension (OS, P<0.002; DSS, P<0.02; RFS, P=0.058) and primary tumour stage (OS, P=0.058; DSS, P<0.02; RFS, P<0.02) added independent prognostic information. Extracapsular extension of lymph node metastases did not correlate with a specific recurrence pattern; patients with organ-confined tumours (pT1/2) never had pelvic relapse.
Extracapsular extension of lymph node metastases but not lymph node tumour burden adds independent prognostic information in lymph node-positive bladder cancer. These biological differences in lymph node-positive bladder cancer are not reflected in the sixth, and challenge future, TNM classification.
评估淋巴结阳性膀胱癌的危险因素。
对术前分期为 N0M0 的淋巴结阳性膀胱癌患者（n=162）行膀胱癌根治术和标准扩大淋巴结清扫术。该队列的 5 年总生存率为 33%。单因素分析显示，肿瘤分期（P<0.006）、淋巴结转移的包膜外扩展（P<0.001）、转移淋巴结的总直径（P<0.04）和淋巴结分期（P<0.03）与总生存率（OS）、疾病特异性生存率（DSS）和无复发生存率（RFS）显著相关。多因素分析显示，只有包膜外扩展（OS，P<0.002；DSS，P<0.02；RFS，P=0.058）和原发肿瘤分期（OS，P=0.058；DSS，P<0.02；RFS，P<0.02）增加了独立的预后信息。淋巴结转移的包膜外扩展与特定的复发模式无关；局限于器官的肿瘤（pT1/2）患者从未出现盆腔复发。
淋巴结转移的包膜外扩展而非淋巴结肿瘤负担在淋巴结阳性膀胱癌中增加了独立的预后信息。这些淋巴结阳性膀胱癌的生物学差异在第六版和未来的 TNM 分类中没有得到反映。
