Kondo Tsunenori, Hara Isao, Takagi Toshio, Kodama Yoshiki, Hashimoto Yasunobu, Kobayashi Hirohito, Iizuka Junpei, Omae Kenji, Yoshida Kazuhiko, Tanabe Kazunari
Int J Urol. 2014 May;21(5):453-9. doi: 10.1111/iju.12417.
Recent studies showed the therapeutic benefit of lymphadenectomy in advanced stage urothelial carcinoma of the upper urinary tract, but there is still a lack of prospective studies and standardization of the extent of lymphadenectomy. The aim of this multi-institutional study was to examine the role of lymphadenectomy in urothelial carcinoma of the upper urinary tract.
From January 2005 to September 2012, 77 patients undergoing nephroureterectomy and lymphadenectomy for non-metastatic (cN0M0) urothelial carcinoma of the upper urinary tract were included in a prospective study at two Japanese institutions(lymphadenectomy group). Lymphadenectomies were carried out according to definite anatomical template. Results from this group were compared with those from a control group of 89 patients who did not receive lymphadenectomy during the study period (no lymphadenectomy group).
In patients with urothelial carcinoma of the upper urinary tract in the renal pelvis of pathological stage 2 or higher, template-based lymphadenectomy resulted in significantly higher cancer-specific survival (89.8% and 51.7%, P = 0.01) and overall survival (86.1% and 48.0%, P = 0.01). Disease-free survival tended to be higher in the lymphadenectomy group(77.8% and 50.0%, P = 0.06). Template-based lymphadenectomy was a significant independent factor for reducing the risk of cancer death in patients with renal pelvic cancer of ≥ pT2 by multivariate analysis. In contrast, cancer-specific survival of patients with ureteral urothelial carcinoma of the upper urinary tract was not significantly different between the lymphadenectomy and no lymphadenectomy groups.
This multi-institutional prospective study further supports the therapeutic role of template-based lymphadenectomy in patients with advanced-stage urothelial carcinoma of the upper urinary tract in the renal pelvis. This is not the case for patients with ureteral urothelial carcinoma of the upper urinary tract.
近期研究显示了淋巴结清扫术在上尿路晚期尿路上皮癌中的治疗益处，但仍缺乏前瞻性研究以及淋巴结清扫范围的标准化。这项多机构研究的目的是探讨淋巴结清扫术在上尿路尿路上皮癌中的作用。
2005年1月至2012年9月，两家日本机构对77例因非转移性（cN0M0）上尿路尿路上皮癌接受肾输尿管切除术和淋巴结清扫术的患者进行了一项前瞻性研究（淋巴结清扫组）。淋巴结清扫按照明确的解剖模板进行。将该组结果与研究期间未接受淋巴结清扫术的89例患者的对照组（无淋巴结清扫组）结果进行比较。
在病理分期为2期或更高的肾盂上尿路尿路上皮癌患者中，基于模板的淋巴结清扫术使癌症特异性生存率（分别为89.8%和51.7%，P = 0.01）和总生存率（分别为86.1%和48.0%，P = 0.01）显著提高。淋巴结清扫组的无病生存率也有升高趋势（分别为77.8%和50.0%，P = 0.06）。多因素分析显示，基于模板的淋巴结清扫术是降低≥pT2肾盂癌患者癌症死亡风险的显著独立因素。相比之下，上尿路输尿管尿路上皮癌患者的癌症特异性生存率在淋巴结清扫组和无淋巴结清扫组之间无显著差异。
这项多机构前瞻性研究进一步支持了基于模板的淋巴结清扫术在晚期肾盂上尿路尿路上皮癌患者中的治疗作用。而上尿路输尿管尿路上皮癌患者并非如此。
