Zehnder Pascal, Moltzahn Felix, Mitra Anirban P, Cai Jie, Miranda Gus, Skinner Eila C, Gill Inderbir S, Daneshmand Siamak
USC Institute of Urology, Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Department of Urology, University of Bern, Bern, Switzerland.
BJU Int. 2016 Feb;117(2):253-9. doi: 10.1111/bju.12956. Epub 2015 Jun 22.
To update our previous analysis of the clinical and pathological impact of the change in the submission of lymphadenectomy specimens from en bloc to 13 separate anatomically defined packets, which took place at the University of Southern California in May 2002, and to determine whether lymph node (LN) packeting resulted in any change in oncological outcomes.
A total of 846 patients who underwent radical cystectomy (RC) with super-extended LN dissection for cTxN0M0 bladder cancer between January 1996 and December 2007 were identified. Specimens of 376 patients were sent en bloc (group 1), and specimens of 470 patients were sent in 13 separate anatomical packets (group 2).
The pathological tumour stage distribution and the proportion of LN-positive patients (group 1: 82 patients [22%] versus group 2: 99 patients [21%]; P = 0.80) were similar between the two groups: the median [range] number of total LNs identified increased significantly (group 1: 32 [10-97] versus group 2: 65 [10-179]; P < 0.001). LN density decreased (group 1, 11% versus group 2, 4%; P = 0.005). The median [range] number of positive LNs removed was similar (group 1: 0 [0-30] versus group 2: 0 [0-97]; P = 0.87). No nodal stage shift was observed. The 5-year overall survival (group 1: 58% versus group 2: 59%; P = 0.65) and recurrence-free survival rates (group 1: 68% versus group 2: 70%; P = 0.57) were similar.
The incidence of patients with positive LNs remained unchanged, regardless of how the LN specimen was submitted. Submitting 13 separate nodal packets significantly increased the total LN yield, but did not result in a significant increase in the number of positive LNs or a consecutive nodal stage shift and did not affect oncological outcomes. Based on these results LN density is not an accurate prognosticator.
更新我们之前关于2002年5月在南加州大学发生的淋巴结切除术标本提交方式从整块提交改为按13个独立的解剖学定义的包块提交的临床和病理影响分析，并确定淋巴结（LN）分包是否导致肿瘤学结局发生任何变化。
确定了1996年1月至2007年12月期间因cTxN0M0膀胱癌接受根治性膀胱切除术（RC）并进行超扩大淋巴结清扫术的846例患者。376例患者的标本整块送检（第1组），470例患者的标本按13个独立的解剖包块送检（第2组）。
两组之间病理肿瘤分期分布以及LN阳性患者比例相似（第1组：82例患者[22%]，第2组：99例患者[21%]；P = 0.80）：识别出的总LN中位数[范围]显著增加（第1组：32[10 - 97]，第2组：65[10 - 179]；P < 0.001）。LN密度降低（第1组，11%，第2组，4%；P = 0.005）。切除的阳性LN中位数[范围]相似（第1组：0[0 - 30]，第2组：0[0 - 97]；P = 0.87）。未观察到淋巴结分期转移。5年总生存率（第1组：58%，第2组：59%；P = 0.65）和无复发生存率（第1组：68%，第2组：70%；P = 0.57）相似。
无论LN标本如何提交，LN阳性患者的发生率均保持不变。提交13个独立的淋巴结包块显著增加了总LN产量，但未导致阳性LN数量显著增加或连续淋巴结分期转移，且未影响肿瘤学结局。基于这些结果，LN密度不是一个准确的预后指标。
