Pedrosa Jose A, Koch Michael O, Kaimakliotis Hristos Z, Monn M Francesca, Masterson Timothy A, Rice Kevin R, Cary K Clint, Foster Richard S, Bihrle Richard, Cheng Liang
Department of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
Future Oncol. 2015;11(3):399-408. doi: 10.2217/fon.14.267.
AIM: To evaluate a three-tiered prognostic stratification using one, two to five and >five positive lymph nodes (LNs) and this nodal staging system performs across different pelvic LN dissection (PLND) templates and adjuvant chemotherapy status. METHODS: We evaluated 244 patients with positive LN urothelial cancer who underwent radical cystectomy and PLND between 2000 and 2011. Survival analyses utilizing the Kaplan-Meier method and log rank test were performed. Median follow-up was 55.3 months (range: 0.4-141). Multivariable Cox proportional hazards models were built to evaluate the prognostic stratification. RESULTS: Extended PLND template was performed on 152 (62.3%) patients and standard on 92 (37.7%). The median number of LNs resected was 14 in the standard group vs 22 in the extended group (p < 0.01) and positive LNs was 2 vs 3 (p = 0.09), respectively. Stratification in patients with: one positive LN, two to five positive LNs or >five positive LNs lead to 5-year recurrence-free survival of: 48.6, 34.5 and 15.9% for each group, while the 5-year overall survival was: 43.0, 22.1 and 11.3%, respectively. Stratification in the three groups was also verified irrespective of PLND template and adjuvant chemotherapy. Two multivariable models confirmed the findings when controlling for demographic features and known pathologic risk factors. CONCLUSION: Three-tiered nodal classification system using the number of metastatic LNs (one, two to five and >five) stratifies patients with lymphatic disease into distinct prognostic groups.
目的:评估使用1个、2至5个和超过5个阳性淋巴结(LN)的三级预后分层,以及该淋巴结分期系统在不同盆腔淋巴结清扫(PLND)模板和辅助化疗状态下的表现。 方法:我们评估了2000年至2011年间接受根治性膀胱切除术和PLND的244例LN阳性尿路上皮癌患者。采用Kaplan-Meier法和对数秩检验进行生存分析。中位随访时间为55.3个月(范围:0.4 - 141个月)。构建多变量Cox比例风险模型以评估预后分层。 结果:152例(62.3%)患者采用了扩大PLND模板,92例(37.7%)采用了标准模板。标准组切除的LN中位数为14个,扩大组为22个(p < 0.01),阳性LN分别为2个和3个(p = 0.09)。按以下情况分层的患者:1个阳性LN、2至5个阳性LN或超过5个阳性LN,每组的5年无复发生存率分别为:48.6%、34.5%和15.9%,而5年总生存率分别为:43.0%、22.1%和11.3%。无论PLND模板和辅助化疗情况如何,三组的分层均得到验证。两个多变量模型在控制人口统计学特征和已知病理危险因素时证实了这些发现。 结论:使用转移LN数量(1个、2至5个和超过5个)的三级淋巴结分类系统将有淋巴疾病的患者分为不同的预后组。