Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Canada.
BJU Int. 2012 Apr;109(8):1147-54. doi: 10.1111/j.1464-410X.2011.10482.x. Epub 2011 Aug 24.
To examine the effect of stage-specific pelvic lymph node dissection (PLND) on cancer-specific (CSM) and overall mortality (OM) rates at radical cystectomy (RC) for bladder cancer.
Overall, 11,183 patients were treated with RC within the Surveillance, Epidemiology, and End Results database. Univariable and multivariable Cox regression analyses tested the effect of PLND on CSM and OM rates, after stratifying according to pathological tumour stage.
Overall, PLND was omitted in 25% of patients, and in 50, 35, 27, 16 and 23% of patients with respectively pTa/is, pT1, pT2, pT3 and pT4 disease (P < 0.001). For the same stages, the 10-year CSM-free rates for patients undergoing PLND compared with those with no PLND were, respectively, 80 vs 71.9% (P = 0.02), 81.7 vs 70.0% (P < 0.001), 71.5 vs 56.1% (P = 0.001), 43.7 vs 38.8% (P = 0.006), and 35.1 vs 32.0% (P = 0.1). In multivariable analyses, PLND omission was associated with a higher CSM in patients with pTa/is, pT1 and pT2 disease (all P ≤ 0.01), but failed to achieve independent predictor status in patients with pT3 and pT4 disease (both P ≥ 0.05). Omitting PLND predisposed to a higher OM across all tumour stages (all P ≤ 0.03).
Our results indicate that PLND was more frequently omitted in patients with organ-confined disease. The beneficial effect of PLND on cancer control outcomes was more evident in these patients than in those with pT3 or pT4 disease. PLND at RC should always be considered, regardless of tumour stage.
研究在膀胱癌根治性切除术（RC）中，根据病理肿瘤分期进行分层后，特定阶段的盆腔淋巴结清扫术（PLND）对癌症特异性（CSM）和总死亡率（OM）的影响。
在 Surveillance, Epidemiology, and End Results 数据库中，共对 11183 例接受 RC 治疗的患者进行了研究。单变量和多变量 Cox 回归分析测试了 PLND 对 CSM 和 OM 率的影响。
总体而言，25%的患者未行 PLND，分别有 50%、35%、27%、16%和 23%的 pTa/is、pT1、pT2、pT3 和 pT4 疾病患者未行 PLND（P < 0.001）。对于相同的分期，行 PLND 与未行 PLND 的患者的 10 年 CSM 无复发生存率分别为 80%与 71.9%（P = 0.02）、81.7%与 70.0%（P < 0.001）、71.5%与 56.1%（P = 0.001）、43.7%与 38.8%（P = 0.006）和 35.1%与 32.0%（P = 0.1）。多变量分析显示，在 pTa/is、pT1 和 pT2 疾病患者中，PLND 遗漏与 CSM 升高相关（均 P ≤ 0.01），但在 pT3 和 pT4 疾病患者中未能成为独立的预测因素（均 P ≥ 0.05）。PLND 遗漏使所有肿瘤分期的 OM 升高（均 P ≤ 0.03）。
我们的结果表明，PLND 在器官局限疾病患者中更常被遗漏。PLND 对癌症控制结果的有益影响在这些患者中比在 pT3 或 pT4 疾病患者中更为明显。无论肿瘤分期如何，RC 时均应考虑行 PLND。
