Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
J Urol. 2011 Jun;185(6):2085-90. doi: 10.1016/j.juro.2011.02.056. Epub 2011 Apr 15.
We examined clinical outcomes in patients with bladder cancer who underwent radical cystectomy and had 1 positive lymph node compared to none or 2 positive lymph nodes.
We retrospectively analyzed data on 525 patients who underwent radical cystectomy and pelvic lymphadenectomy for urothelial carcinoma of the bladder and who had none, 1 or 2 positive lymph nodes. The effect of several variables on recurrence-free and disease specific survival was assessed.
Of the 525 patients pathological analysis revealed no positive lymph nodes in 448 with organ confined disease (311 or 59.2%) or extravesical disease (137 or 26.1%), 1 positive lymph node in 54 (10.3%) and 2 positive lymph nodes in 23 (4.4%). Five-year recurrence-free and disease specific survival rates were 36.9% and 52.2% in patients with 1 positive lymph node, 51.9% and 56.6% in those with extravesical lymph node negative disease (p = 0.178 and 0.504), and 16.3% and 21.7% in those with 2 positive lymph nodes (p = 0.027 and 0.036, respectively). Multivariate analysis showed that 2 positive lymph nodes were associated with lower recurrence-free and disease specific survival than 1 positive lymph node (HR 2.03, p = 0.021 and HR 2.20, p = 0.015, respectively). However, recurrence-free and disease specific survival rates were not statistically different between patients with extravesical lymph node negative disease and those with 1 positive lymph node (HR 0.70, p = 0.162 and HR 0.72, p = 0.219, respectively) after adjusting for other prognostic variables.
Patients with 1 positive lymph node had a prognosis similar to that in lymph node negative patients with extravesical extension. Patients with 1 positive lymph node had a better prognosis than those with 2 positive lymph nodes.
我们研究了接受根治性膀胱切除术且淋巴结阳性 1 枚与无淋巴结阳性或 2 枚淋巴结阳性的膀胱癌患者的临床结局。
我们回顾性分析了 525 例接受根治性膀胱切除术和盆腔淋巴结清扫术治疗膀胱尿路上皮癌的患者的数据，这些患者的淋巴结均无阳性、1 枚阳性或 2 枚阳性。评估了几个变量对无复发生存和疾病特异性生存的影响。
在 525 例患者中，病理分析显示 448 例（311 例，59.2%；137 例，26.1%）为器官局限性疾病或外侵性疾病，淋巴结无阳性；54 例（10.3%）为 1 枚淋巴结阳性，23 例（4.4%）为 2 枚淋巴结阳性。1 枚淋巴结阳性患者的 5 年无复发生存率和疾病特异性生存率分别为 36.9%和 52.2%，外侵性淋巴结阴性疾病患者分别为 51.9%和 56.6%（p = 0.178 和 0.504），2 枚淋巴结阳性患者分别为 16.3%和 21.7%（p = 0.027 和 0.036）。多变量分析显示，2 枚淋巴结阳性与较低的无复发生存率和疾病特异性生存率相关，与 1 枚淋巴结阳性相比（HR 2.03，p = 0.021 和 HR 2.20，p = 0.015）。然而，在外侵性淋巴结阴性疾病患者与 1 枚淋巴结阳性患者之间，调整其他预后变量后，无复发生存率和疾病特异性生存率无统计学差异（HR 0.70，p = 0.162 和 HR 0.72，p = 0.219）。
1 枚淋巴结阳性患者的预后与外侵性疾病且淋巴结阴性的患者相似。1 枚淋巴结阳性患者的预后优于 2 枚淋巴结阳性患者。
