Department of Urology, Regina Elena National Cancer Institute, Rome, Italy.
Int J Urol. 2013 Apr;20(4):390-7. doi: 10.1111/j.1442-2042.2012.03148.x. Epub 2012 Sep 12.
To evaluate the impact of an extended versus a standard pelvic lymph node dissection on disease-free survival and cancer-specific survival of patients with non-metastatic muscle-invasive urothelial carcinoma of the bladder treated with radical cystectomy.
We retrospectively analyzed data of 933 patients collected in two prospectively-maintained institutional databases between 2002 and 2010. Patients who met inclusion criteria (high-grade urothelial carcinoma, have not undergone neoadjuvant treatments, have not undergone salvage cystectomy) were included for analysis. The upper boundary was the iliac bifurcation for standard lymph-node dissection and the aortic bifurcation for the extended lymph node dissection, respectively. Univariable and multivariable Cox regression analyses were carried out to identify independent predictors of disease-free survival and cancer-specific survival and, subsequently, the effect of extended lymph node dissection was determined with a multivariable Cox analysis after stratifying for significant covariates.
At multivariable analysis, once adjusted for the effect of the other covariates, extended lymph node dissection was an independent predictor of disease-free survival (hazard ratio 1.95, P < 0.001) and cancer-specific survival (hazard ratio 1.80, P < 0.001). The benefit of an extended pelvic lymph node dissection on disease-free survival and cancer-specific survival was significant across all pT stages (all P < 0.05) except for pT <2 and across all pN stages (pN = 0, P = 0.011 and P = 0.034 for disease-free survival and cancer-specific survival, respectively; pN1 and pN2, all P < 0.001).
The staging accuracy and the survival benefit provided by extended pelvic lymph node dissection suggests the adoption of this template as the standard template for patients with muscle-invasive urothelial carcinoma of the bladder undergoing radical cystectomy.
评估广泛与标准盆腔淋巴结清扫术对接受根治性膀胱切除术的非转移性肌层浸润性膀胱癌患者无病生存率和癌症特异性生存率的影响。
我们回顾性分析了 2002 年至 2010 年期间在两个前瞻性维护的机构数据库中收集的 933 例患者的数据。符合纳入标准（高级别尿路上皮癌、未接受新辅助治疗、未接受挽救性膀胱切除术）的患者纳入分析。标准淋巴结清扫术的上界为骼内分叉，扩展淋巴结清扫术的上界为主动脉分叉。进行单变量和多变量 Cox 回归分析，以确定无病生存率和癌症特异性生存率的独立预测因素，随后在分层有显著协变量后，通过多变量 Cox 分析确定扩展淋巴结清扫术的效果。
在多变量分析中，一旦调整了其他协变量的影响，扩展淋巴结清扫术是无病生存率（危险比 1.95，P<0.001）和癌症特异性生存率（危险比 1.80，P<0.001）的独立预测因素。扩展盆腔淋巴结清扫术对无病生存率和癌症特异性生存率的获益在所有 pT 分期（所有 P<0.05）中均显著，除了 pT<2 外，在所有 pN 分期中（pN=0，P=0.011 和 P=0.034 用于无病生存率和癌症特异性生存率；pN1 和 pN2，所有 P<0.001）。
扩展盆腔淋巴结清扫术的分期准确性和生存获益提示采用该模板作为接受根治性膀胱切除术的肌层浸润性膀胱癌患者的标准模板。
