Feuerstein Michael A, Kent Matthew, Bazzi Wassim M, Bernstein Melanie, Russo Paul
Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA,
World J Urol. 2014 Dec;32(6):1531-6. doi: 10.1007/s00345-013-1233-x. Epub 2014 Jan 9.
To analyze the role of lymph node dissection (LND) in patients with large renal tumors.
We performed a retrospective study of patients with renal cell carcinoma ≥7 cm in size undergoing surgery between 1990 and 2012. Primary outcome measures were recurrence-free and overall survival of patients who did and did not undergo LND. Cox proportional hazards regression models were created to account for known risk factors for recurrence and survival. Secondary outcomes were recurrence-free and overall survival by lymph node status, lymph node template and number of lymph nodes removed.
Of 524 patients, 164 had disease recurrence and 197 died. Median follow-up was 5 and 5.5 years for patients who did not die or have a recurrence, respectively. A total of 334 (64 %) patients underwent LND, and node-positive disease was identified in 26 (8 %). For patients who did and did not undergo LND, 5-year recurrence-free survival was 64 and 77 %, respectively. Five-year overall survival was 75 and 78 %, respectively. LND was not a predictor of recurrence or survival in multivariate analysis. Node-positive disease was associated with recurrence (p < 0.0005) and mortality (p = 0.032), although node-positive patients had a 5-year overall survival of 65 %.
We did not find a difference in recurrence-free or overall survival in patients with ≥7-cm tumors whether or not they underwent LND. Node-positive disease was associated with worse outcomes, suggesting that LND provides important staging information that can be important in the design of adjuvant clinical trials.
分析淋巴结清扫术(LND)在大体积肾肿瘤患者中的作用。
我们对1990年至2012年间接受手术的肾细胞癌大小≥7 cm的患者进行了一项回顾性研究。主要观察指标是接受和未接受LND的患者的无复发生存率和总生存率。建立Cox比例风险回归模型以考虑已知的复发和生存风险因素。次要观察指标是按淋巴结状态、淋巴结模板和切除淋巴结数量划分的无复发生存率和总生存率。
524例患者中,164例出现疾病复发,197例死亡。未死亡或未复发患者的中位随访时间分别为5年和5.5年。共有334例(64%)患者接受了LND,其中26例(8%)被确诊为淋巴结阳性疾病。接受和未接受LND的患者,5年无复发生存率分别为64%和77%。5年总生存率分别为75%和78%。在多变量分析中,LND不是复发或生存的预测因素。淋巴结阳性疾病与复发(p < 0.0005)和死亡率(p = 0.032)相关,尽管淋巴结阳性患者的5年总生存率为65%。
我们发现,肿瘤大小≥7 cm的患者无论是否接受LND,其无复发生存率或总生存率均无差异。淋巴结阳性疾病与较差的预后相关,这表明LND提供了重要的分期信息,在辅助性临床试验设计中可能很重要。