Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Eur Urol. 2011 Sep;60(3):572-7. doi: 10.1016/j.eururo.2011.05.062. Epub 2011 Jun 12.
Controversy exists regarding the optimal extent of lymphadenectomy and the number of lymph nodes to be retrieved at radical cystectomy (RC).
To compare the disease-free survival of patients with standard lymphadenectomy (endopelvic region composed of the internal, external iliac, and obturator groups of lymph nodes) versus extended lymphadenectomy (up to the level of origin of the inferior mesenteric artery) at RC in a prospective cohort of patients at a single, high-volume center.
DESIGN, SETTING, AND PARTICIPANTS: Prospective data were collected from 400 consecutive patients treated with RC for bladder cancer by two high-volume surgeons at Mansoura Urology and Nephrology Center. Of the 400 patients, 200 (50%) received extended lymphadenectomy and the other 200 (50%) underwent standard lymphadenectomy at RC. The patients did not receive any neoadjuvant or adjuvant therapy.
Patient characteristics and outcomes are evaluated.
Median patient age for the entire group was 53.0 yr. Ninety-six patients (24.0%) had lymph node metastases. Median follow-up was 50.2 mo. Estimates of 5-yr disease-free survival in the extended lymphadenectomy group were 66.6% compared with 54.7% for patients with standard lymphadenectomy (p = 0.043). Extended lymphadenectomy was associated with better disease-free survival after adjusting for the effects of standard pathologic features (p = 0.02). When restricting the analyses to lymph node-positive patients, patients with extended lymphadenectomy had much better 5-yr disease-free survival compared with patients with standard lymphadenectomy (48.0% vs 28.2%; p = 0.029). The study was nonrandomized.
Extended lymphadenectomy is associated with better disease-free survival for bladder cancer patients with endopelvic lymph node involvement and should be considered in these patients.
在根治性膀胱切除术（RC）中，关于淋巴结清扫的最佳范围和需要切除的淋巴结数量存在争议。
在单一高容量中心的前瞻性队列中，比较标准淋巴结清扫（包括内、外髂和闭孔淋巴结组的盆内区域）与 RC 中扩展淋巴结清扫（至肠系膜下动脉起源水平）的无病生存率。
设计、地点和参与者：前瞻性数据来自由两位高容量外科医生在 Mansoura Urology and Nephrology Center 治疗的 400 例膀胱癌 RC 连续患者。在 400 例患者中，200 例（50%）接受了扩展淋巴结清扫术，另 200 例（50%）接受了 RC 的标准淋巴结清扫术。患者未接受任何新辅助或辅助治疗。
评估患者特征和结局。
整个组的中位患者年龄为 53.0 岁。96 例（24.0%）有淋巴结转移。中位随访时间为 50.2 个月。在扩展淋巴结清扫组中，5 年无病生存率估计为 66.6%，而标准淋巴结清扫组为 54.7%（p=0.043）。在调整标准病理特征的影响后，扩展淋巴结清扫与更好的无病生存率相关（p=0.02）。当将分析限制在淋巴结阳性患者时，与标准淋巴结清扫相比，接受扩展淋巴结清扫的患者 5 年无病生存率更高（48.0%对 28.2%；p=0.029）。该研究是非随机的。
对于盆内淋巴结受累的膀胱癌患者，扩展淋巴结清扫与更好的无病生存率相关，因此应在这些患者中考虑。
