Brady Urologic Health Center, Weill Cornell Medical College of Cornell University, New York Presbyterian Hospital, 525 East 68th Street, Box 94, Starr 900, New York, NY, USA.
World J Urol. 2012 Dec;30(6):807-14. doi: 10.1007/s00345-012-0910-5. Epub 2012 Jul 26.
To determine whether the number of lymph nodes (LNs) examined is associated with outcomes in patients without nodal metastasis after radical cystectomy (RC).
We retrospectively analyzed data from 4,188 patients treated at 12 centers with RC and pelvic lymphadenectomy without neo-adjuvant chemotherapy for urothelial carcinoma of the bladder (UCB). Outcomes of patients without LN metastasis (n = 3,088) were examined according to the LN yield analyzed as continuous variable, tertiles, and using the cutoffs of ≥ 9 and ≥ 20.
The median nodal yield was 18 (range 1-123; IQR:20). A total of 2591 (84 %) and 1445 (47 %) patients had a LN yield ≥ 9 and ≥ 20, respectively. Median follow-up was 47 months (IQR:70). In multivariable analyses that adjusted for the standard clinicopathologic factors, higher LN yield was associated with a decreased risk of disease recurrence (continuous: HR = 0.996, p = 0.05; 3rd vs 1st tertile: HR = 0.853, p = 0.048; cutoff ≥ 20: HR = 0.851, p = 0.032). In the subgroups of patients with muscle-invasive UCB or those with ≥ 9 LN removed, LN yield was not associated with outcomes (p values >0.05).
In this large multicenter cohort of patients with node-negative UCB, higher nodal yield improved recurrence-free survival when all patients were analyzed. Patients with a high LN yield (≥ 20 LN removed or 3rd tertile) had the largest benefit. The lack of prognostic significance of LN yield in patients with muscle-invasive UCB or those stratified by 9 LNs removed suggests that this effect is weak. Further prospective studies are needed to help identify preoperatively the optimal template for each patient.
确定在接受根治性膀胱切除术（RC）且无新辅助化疗的淋巴结转移阴性患者中，检查的淋巴结（LNs）数量是否与结局相关。
我们回顾性分析了 12 个中心治疗的 4188 例接受 RC 和盆腔淋巴结清扫术且无新辅助化疗的膀胱癌（UCB）患者的数据。根据 LN 产量作为连续变量、三分位数进行分析，并使用≥9 和≥20 的截止值，检查无 LN 转移（n=3088）患者的结局。
中位淋巴结产量为 18（范围 1-123；IQR：20）。共有 2591（84%）和 1445（47%）例患者的 LN 产量≥9 和≥20。中位随访时间为 47 个月（IQR：70）。在调整了标准临床病理因素的多变量分析中，较高的 LN 产量与降低疾病复发风险相关（连续：HR=0.996，p=0.05；第 3 与第 1 三分位：HR=0.853，p=0.048；截止值≥20：HR=0.851，p=0.032）。在肌层浸润性 UCB 患者或 LN 切除≥9 例的患者亚组中，LN 产量与结局无关（p 值>0.05）。
在这项针对淋巴结阴性 UCB 患者的大型多中心队列研究中，当所有患者进行分析时，较高的淋巴结产量提高了无复发生存率。高 LN 产量（≥20 LN 切除或第 3 三分位）患者获益最大。在肌层浸润性 UCB 患者或按 9 个 LN 切除分层的患者中，LN 产量无预后意义表明这种作用较弱。需要进一步的前瞻性研究来帮助确定每位患者的最佳模板。
