Horn Thomas, Schmid Sebastian C, Seitz Anna K, Grab Jessica, Wolf Petra, Haller Bernhard, Retz Margitta, Maurer Tobias, Autenrieth Michael, Kübler Hubert R, Gschwend Jürgen E
Department of Urology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany,
World J Urol. 2015 Jun;33(6):813-9. doi: 10.1007/s00345-014-1355-9. Epub 2014 Jul 10.
Patients with lymph node-positive urothelial carcinoma of the bladder generally have a poor prognosis. Nevertheless, long-term survival in up to 30% of patients is reported. In the absence of established prognostic molecular markers, an assessment of the prognosis with clinical parameters is mandatory.
All patients from one high-volume center with a curatively intended cystectomy for lymph node-positive urothelial carcinoma were evaluated. Patients' overall and cancer-specific survival were correlated with clinicopathological parameters. Pathological lymph node staging was performed with both the 2002 and 2010 TNM classification of the AJCC.
Lack of a perioperative chemotherapy (p < 0.001), higher numbers of positive nodes (p = 0.002), a higher lymph node density (p = 0.003), a higher pathological T stage (p = 0.006) and urinary diversion with an ileal conduit compared to an ileal neobladder (p = 0.023) were prognostic of a shorter overall survival while the number of removed lymph nodes showed no significant association with survival. Both with the 2002 and 2010 TNM classifications patients staged pN1 had a longer overall survival and time to cancer-specific death in comparison to patients with more extensive lymph node disease. According to the 2002 classification, there was a significant survival difference between patients with lymph node metastases in regional and distant lymph nodes.
Patients with a low lymph node density and an early pT stage present with the best prognosis among LN positive patients. The value of perioperative chemotherapy is emphasized. Which lymph node metastases are to be considered regional or distant remains a matter of debate.
淋巴结阳性的膀胱尿路上皮癌患者预后通常较差。然而，据报道高达30%的患者可长期存活。在缺乏既定的预后分子标志物的情况下，必须用临床参数评估预后。
对来自一个高容量中心、因淋巴结阳性膀胱尿路上皮癌接受根治性膀胱切除术的所有患者进行评估。将患者的总生存期和癌症特异性生存期与临床病理参数相关联。病理淋巴结分期采用美国癌症联合委员会（AJCC）2002年和2010年的TNM分类。
未进行围手术期化疗（p<0.001）、阳性淋巴结数量较多（p=0.002）、淋巴结密度较高（p=0.003）、病理T分期较高（p=0.006）以及与回肠新膀胱相比采用回肠导管进行尿流改道（p=0.023）均提示总生存期较短，而切除的淋巴结数量与生存期无显著关联。根据2002年和2010年的TNM分类，与淋巴结疾病更广泛的患者相比，pN1期患者的总生存期和癌症特异性死亡时间更长。根据2002年分类，区域淋巴结转移患者和远处淋巴结转移患者之间存在显著的生存差异。
淋巴结密度低且pT分期早的患者在淋巴结阳性患者中预后最佳。强调了围手术期化疗的价值。哪些淋巴结转移应视为区域转移或远处转移仍存在争议。
