Park Won Kyu, Kim Young Sig
Department of Urology, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea.
Korean J Urol. 2012 Jan;53(1):14-7. doi: 10.4111/kju.2012.53.1.14. Epub 2012 Jan 25.
Resection of a large number of lymph nodes (LNs) increases survival in patients with LN-positive disease; however, morbidity also increases. Here, we investigated the correlation between tumor location and LN metastasis in bladder cancer.
Thirty-six patients with pathological N1 or higher bladder cancer, who underwent radical cystectomy with extended lymphadenectomy, were reviewed retrospectively. The tumor location was classified as right, left, front, posterior, or whole bladder. The LN metastasis pattern was classified as right, left, or bilateral. The correlation between tumor location and LN metastasis was determined by chi-square test. Survival rates were compared by Kaplan-Meier analysis.
The numbers of patients with a tumor on the right (group 1), left (group 2), posterior (group 3), or whole (group 4) bladder were 16 (44.4%), 16 (44.4%), 2 (5.6%), and 2 (5.6%), respectively. In group 1, 14 patients (87.5%) had right-sided ipsilateral LNs, and 2 patients (12.5%) had left-sided contralateral LNs. In group 2, 4 patients (25%) had right-sided contralateral LNs, and 12 patients (75%) had left-sided ipsilateral LNs. In group 3, both patients (100%) had right-sided posterior LNs. In group 4, both patients (100%) had positive LNs on both sides. Tumor location and LN metastasis were significantly correlated (p<0.05). Moreover, the survival rate was significantly higher in patients with no LN metastasis than in patients with ipsilateral or contralateral LN-positive bladder cancer.
The location of the bladder tumor and direction of metastatic spread were significantly correlated. Mandatory bilateral lymphadenectomy during radical cystectomy should be questioned.
切除大量淋巴结可提高淋巴结阳性疾病患者的生存率；然而，发病率也会增加。在此，我们研究了膀胱癌肿瘤位置与淋巴结转移之间的相关性。
回顾性分析36例接受根治性膀胱切除术及扩大淋巴结清扫术的病理N1或更高分期的膀胱癌患者。肿瘤位置分为右侧、左侧、前部、后部或全膀胱。淋巴结转移模式分为右侧、左侧或双侧。采用卡方检验确定肿瘤位置与淋巴结转移之间的相关性。通过Kaplan-Meier分析比较生存率。
肿瘤位于右侧（第1组）、左侧（第2组）、后部（第3组）或全膀胱（第4组）的患者数量分别为16例（44.4%）、16例（44.4%）、2例（5.6%）和2例（5.6%）。在第1组中，14例患者（87.5%）有右侧同侧淋巴结转移，2例患者（12.5%）有左侧对侧淋巴结转移。在第2组中，4例患者（25%）有右侧对侧淋巴结转移，12例患者（75%）有左侧同侧淋巴结转移。在第3组中，2例患者（100%）均有右侧后部淋巴结转移。在第4组中，2例患者（100%）双侧淋巴结均为阳性。肿瘤位置与淋巴结转移显著相关（p<0.05）。此外，无淋巴结转移患者的生存率显著高于同侧或对侧淋巴结阳性的膀胱癌患者。
膀胱肿瘤的位置与转移扩散方向显著相关。根治性膀胱切除术中强制性双侧淋巴结清扫术值得质疑。
