Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY 10065, USA.
BJU Int. 2013 Jan;111(1):74-84. doi: 10.1111/j.1464-410X.2012.11356.x. Epub 2012 Jul 19.
To identify clinicopathological factors that predict outcomes in patients with a single lymph node (LN) metastasis (pN1) treated with radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). LN metastasis is an established predictor of clinical outcomes in patients. While most patients with large LN burden experience disease recurrence, lymphadenectomy can be curative in patients with pN1 disease.
We analysed 381 patients with pN1 UCB from a multi-institutional cohort of 4335 patients with UCB treated with RC and lymphadenectomy without preoperative chemo- or radiotherapy. Subgroup analyses were performed for patients with ≥9 LNs removed and according to adjuvant chemotherapy administration (n = 215).
The median (interquartile range, IQR) LN number was 15 (19) and the median (IQR) LN density was 6.7 (7.5)%. Within a median follow-up of 41 months, the mean (+/- SD) 2- and 5-year cancer-specific survival (CSS) rates were 55 (3)% and 46 (3)%, respectively. On multivariable analysis that adjusted for the effects of standard clinicopathological features, female gender (hazard ratio [HR] 1.48, P = 0.023), higher tumour stage (HR 1.68, P = 0.007), positive soft tissue surgical margin (STSM; HR 2.06, P = 0.004), higher LN density (HR 2.99, P = 0.025) and absence of adjuvant chemotherapy (HR 0.70, P = 0.026) were independently associated with CSS. In subgroup analyses of patients with ≥9 LNs removed, tumour stage and STSM status remained independent predictors for CSS (P = 0.009 and P < 0.001, respectively).
About half of the patients with pN1 UCB died from UCB within 5 years of RC. Pathological stage and STSM status are strong predictors for outcomes. Accurate prediction of the individual risk of CSS may help risk stratifying pN1 UCB in order to help improve clinical-decision making. Patients with pN1 UCB presenting with additional unfavourable risk factors need a closer follow-up scheduling and might receive adjuvant therapy.
确定预测接受根治性膀胱切除术（RC）治疗的膀胱癌（UCB）患者单个淋巴结（LN）转移（pN1）的临床病理因素。LN 转移是患者临床结局的既定预测因素。虽然大多数 LN 负担较大的患者会出现疾病复发，但在 pN1 疾病患者中，淋巴结切除术可以达到治愈效果。
我们分析了来自多机构队列的 4335 例接受 RC 和淋巴结切除术治疗的 UCB 患者中 381 例 pN1 UCB 患者的数据，这些患者在术前未接受化疗或放疗。对淋巴结切除数≥9 个的患者进行了亚组分析，并根据辅助化疗的应用情况进行了分析（n=215）。
中位（四分位数范围，IQR）LN 数为 15（19），中位（IQR）LN 密度为 6.7（7.5）%。在中位随访 41 个月期间，平均（+/-SD）2 年和 5 年的癌症特异性生存率（CSS）分别为 55（3）%和 46（3）%。多变量分析调整了标准临床病理特征的影响后，女性（危险比[HR]1.48，P=0.023）、较高的肿瘤分期（HR 1.68，P=0.007）、阳性软组织手术切缘（HR 2.06，P=0.004）、较高的 LN 密度（HR 2.99，P=0.025）和缺乏辅助化疗（HR 0.70，P=0.026）与 CSS 独立相关。在淋巴结切除数≥9 个的患者亚组分析中，肿瘤分期和 STSM 状态仍然是 CSS 的独立预测因素（P=0.009 和 P<0.001）。
大约一半的 pN1 UCB 患者在接受 RC 后 5 年内死于 UCB。病理分期和 STSM 状态是强有力的预后预测因素。准确预测 CSS 的个体风险有助于对 pN1 UCB 进行风险分层，以帮助改善临床决策。具有附加不利风险因素的 pN1 UCB 患者需要更密切的随访安排，并可能接受辅助治疗。
