Feuerstein Michael A, Kent Matthew, Bernstein Melanie, Russo Paul
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Int J Urol. 2014 Sep;21(9):874-9. doi: 10.1111/iju.12457. Epub 2014 Apr 8.
To assess whether regional lymph node dissection could improve the prognosis of patients with metastatic renal cell carcinoma.
We reviewed data on 258 patients who underwent cytoreductive nephrectomy at Memorial Sloan Kettering Cancer Center, New York, USA, some of whom received a concurrent lymph node dissection. The primary outcome measure was overall survival. A Cox proportional hazards regression model included, age, pathological stage, lymphadenopathy, tumor size, modified Memorial Sloan Kettering Cancer Center criteria, site of metastatic disease and lymph node dissection. We created a logistic regression model to evaluate risk factors for node-positive disease. Survival analyses were carried out for lymph node template (hilar vs other) and number of nodes removed (0-3, 4-7 or ≥8).
Of 258 patients, 177 (69%) underwent lymph node dissection, and positive nodes were found in 59 (33%). The 5-year overall survival was 21% for patients who underwent lymph node dissection and 31% for patients who did not. No significant difference in survival was found among patients receiving or not receiving lymph node dissection. The 5-year overall survival was 27% and 9% for negative and positive nodal status, respectively (P < 0.0005). For patients who underwent lymph node dissection, the presence of lymphadenopathy was a significant predictor of node-positive disease (odds ratio 25.0, 95% confidence interval 9.04-69.4, P < 0.0001).
Lymph node dissection carried out during cytoreductive nephrectomy is not associated with a survival benefit. Lymph node-positive disease represents a poor prognostic variable; therefore, lymph node dissection should be considered as a staging procedure for clinical trials.
评估区域淋巴结清扫术能否改善转移性肾细胞癌患者的预后。
我们回顾了美国纽约纪念斯隆凯特琳癌症中心258例行减瘤性肾切除术患者的数据，其中部分患者同时接受了淋巴结清扫术。主要观察指标为总生存期。Cox比例风险回归模型纳入了年龄、病理分期、淋巴结病、肿瘤大小、改良的纪念斯隆凯特琳癌症中心标准、转移病灶部位和淋巴结清扫术。我们建立了一个逻辑回归模型来评估淋巴结阳性疾病的危险因素。对淋巴结模板（肾门 vs 其他）和切除淋巴结数量（0 - 3个、4 - 7个或≥8个）进行生存分析。
258例患者中，177例（69%）接受了淋巴结清扫术，59例（33%）发现有阳性淋巴结。接受淋巴结清扫术的患者5年总生存率为21%，未接受者为31%。接受或未接受淋巴结清扫术的患者在生存率上无显著差异。淋巴结阴性和阳性状态的患者5年总生存率分别为27%和9%（P < 0.0005）。对于接受淋巴结清扫术的患者，存在淋巴结病是淋巴结阳性疾病的显著预测因素（比值比25.0，95%置信区间9.04 - 69.4，P < 0.0001）。
减瘤性肾切除术中进行的淋巴结清扫术与生存获益无关。淋巴结阳性疾病是一个预后不良的变量；因此，淋巴结清扫术应被视为临床试验的一种分期程序。
