Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York 10065, USA.
J Urol. 2012 Mar;187(3):845-51. doi: 10.1016/j.juro.2011.10.158. Epub 2012 Jan 15.
We assessed the prognostic value of extranodal extension and other lymph node parameters in a large multicenter cohort of patients with lymph node metastasis after radical nephroureterectomy.
We retrospectively analyzed the records of 222 patients with lymph node metastasis treated with radical nephroureterectomy for upper tract urothelial carcinoma without neoadjuvant therapy. Each lymph node metastasis was microscopically evaluated for extranodal extension.
A median of 4 lymph nodes (IQR 8) was removed. Two lymph nodes (IQR 2) were positive. Lymph node density was 51.3% (IQR 71.7%). Overall 110 patients (49.5%) had extranodal extension, which was associated with more advanced pT stage (p = 0.026). On multivariable analysis extranodal extension was associated with disease recurrence (p = 0.01) and cancer specific mortality (p = 0.013). When stratified by a 30% cutoff, lymph node density was associated with disease recurrence and cancer specific mortality on univariable but not multivariable analysis (p = 0.048 and 0.049, respectively). Adding extranodal extension to a multivariable model including pT stage and tumor architecture improved predictive accuracy for disease recurrence from 70.3% to 74.5% (p <0.001). Adding extranodal extension to a multivariable model including age, pT stage and tumor architecture improved predictive accuracy for cancer specific mortality from 70.6% to 74.4% (p <0.001).
Extranodal extension is a powerful predictor of clinical outcomes in patients with upper tract urothelial carcinoma with lymph node metastasis. While other lymph node parameters seem to have limited clinical value, extranodal extension could help risk stratify patients with upper tract urothelial carcinoma and lymph node metastasis for better counseling and clinical trial design.
我们评估了在根治性肾输尿管切除术治疗后发生淋巴结转移的大型多中心队列患者中，结外侵犯和其他淋巴结参数的预后价值。
我们回顾性分析了 222 例未接受新辅助治疗的上尿路上皮癌患者接受根治性肾输尿管切除术治疗后发生淋巴结转移的患者记录。对每个淋巴结转移灶进行了显微镜下的结外侵犯评估。
中位数切除了 4 个淋巴结（IQR8）。2 个淋巴结（IQR2）阳性。淋巴结密度为 51.3%（IQR71.7%）。总体上 110 例（49.5%）患者存在结外侵犯，与更晚期的 pT 分期相关（p=0.026）。多变量分析显示，结外侵犯与疾病复发（p=0.01）和癌症特异性死亡率（p=0.013）相关。当以 30%的截断值分层时，淋巴结密度在单变量分析中与疾病复发和癌症特异性死亡率相关，但在多变量分析中不相关（分别为 p=0.048 和 0.049）。在包括 pT 分期和肿瘤结构的多变量模型中加入结外侵犯，可使疾病复发的预测准确性从 70.3%提高到 74.5%（p＜0.001）。在包括年龄、pT 分期和肿瘤结构的多变量模型中加入结外侵犯，可使癌症特异性死亡率的预测准确性从 70.6%提高到 74.4%（p＜0.001）。
结外侵犯是上尿路上皮癌伴淋巴结转移患者临床结局的有力预测因子。虽然其他淋巴结参数似乎具有有限的临床价值，但结外侵犯可帮助对具有上尿路上皮癌和淋巴结转移的患者进行风险分层，以更好地进行咨询和临床试验设计。
