Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195-0001, USA.
J Urol. 2011 Oct;186(4):1269-73. doi: 10.1016/j.juro.2011.05.088. Epub 2011 Aug 17.
We evaluated the incidence of positive lymph nodes in the presacral and retroperitoneal regions in patients who underwent radical cystectomy and extended pelvic lymph node dissection for urothelial bladder cancer.
As part of a prospective mapping study, 143 patients underwent radical cystectomy and extended pelvic lymph node dissection for urothelial bladder cancer between 2006 and 2010. Lymph nodes from 6 separate regions were labeled, including bilateral pelvic and common iliac, presacral and retroperitoneal. We evaluated pathological features, treatment outcomes and cancer specific survival in patients with or without lymph node positive disease in the presacral and retroperitoneal regions.
A median of 37 lymph nodes (IQR 27-49) were removed. Overall 52 (36%) patients had positive lymph nodes, of whom 24 (46%) had metastatic disease in the presacral or retroperitoneal region. Four patients (3%) had an isolated solitary positive lymph node in these 2 templates. Two-year overall survival in patients without vs with presacral/retroperitoneal lymph node positive disease was 44% (95% CI 24-64) vs 25% (95% CI 5-45) (p = 0.11). In contrast, 2-year cancer specific survival in the 2 groups was 55% (95% CI 33-77) and 29% (95% CI 7-51), respectively (p = 0.02).
A substantial proportion of patients have lymph node positive disease in the presacral and retroperitoneal regions, including some with isolated and/or solitary lymph node involvement. While the limited positive lymph node burden in these templates suggests a potential therapeutic role for extending the anatomical boundaries of lymph node dissection, patient survival was poor. Extended lymph node dissection provides important staging information but to our knowledge the therapeutic benefit has yet to be definitively proved.
我们评估了在接受根治性膀胱切除术和盆腔淋巴结扩大切除术的患者中，前盆腔和后腹膜区域阳性淋巴结的发生率。
作为一项前瞻性绘图研究的一部分，2006 年至 2010 年间，143 例接受根治性膀胱切除术和盆腔淋巴结扩大切除术的患者患有尿路上皮膀胱癌。对 6 个不同区域的淋巴结进行标记，包括双侧骨盆和髂总、前盆腔和后腹膜。我们评估了前盆腔和后腹膜区域淋巴结阳性患者与无淋巴结阳性患者的病理特征、治疗结果和癌症特异性生存情况。
中位数为 37 个淋巴结（IQR 27-49）。共有 52 例（36%）患者淋巴结阳性，其中 24 例（46%）前盆腔或后腹膜区域有转移病灶。在这两个模板中，有 4 例（3%）患者仅有孤立的阳性淋巴结。无前盆腔/后腹膜淋巴结阳性疾病的患者与有前盆腔/后腹膜淋巴结阳性疾病的患者相比，2 年总生存率分别为 44%（95%CI 24-64）和 25%（95%CI 5-45）（p=0.11）。相比之下，两组患者的 2 年癌症特异性生存率分别为 55%（95%CI 33-77）和 29%（95%CI 7-51）（p=0.02）。
相当一部分患者在前盆腔和后腹膜区域有淋巴结阳性疾病，包括一些有孤立和/或孤立淋巴结受累的患者。尽管这些模板中阳性淋巴结的负荷有限，提示扩大淋巴结清扫的解剖边界具有潜在的治疗作用，但患者的生存率仍然很差。扩大淋巴结清扫提供了重要的分期信息，但据我们所知，其治疗益处尚未得到明确证实。
