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膀胱癌的三层淋巴结分类系统:一项新提议。

Three-tiered nodal classification system for bladder cancer: a new proposal.

作者信息

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

机构信息

Department of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.

出版信息

Future Oncol. 2015;11(3):399-408. doi: 10.2217/fon.14.267.


DOI:10.2217/fon.14.267
PMID:25675122
Abstract

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.

摘要

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。

相似文献

[1]
Three-tiered nodal classification system for bladder cancer: a new proposal.

Future Oncol. 2015

[2]
Extranodal extension is a powerful prognostic factor in bladder cancer patients with lymph node metastasis.

Eur Urol. 2012-7-20

[3]
Critical evaluation of the American Joint Committee on Cancer TNM nodal staging system in patients with lymph node-positive disease after radical cystectomy.

Eur Urol. 2012-5-4

[4]
Critical analysis of the 2010 TNM classification in patients with lymph node-positive bladder cancer: influence of lymph node disease burden.

Urol Oncol. 2014-10

[5]
Radical cystectomy and extended pelvic lymphadenectomy: survival of patients with lymph node metastasis above the bifurcation of the common iliac vessels treated with surgery only.

J Urol. 2007-10

[6]
Role of lymph node density in predicting survival of patients with lymph node metastases after radical cystectomy: a multi-institutional study.

Int J Urol. 2009-3

[7]
Significance of perivesical lymph nodes in radical cystectomy for bladder cancer.

Urol Oncol. 2014-11

[8]
Outcomes of radical cystectomy with extended lymphadenectomy alone in patients with lymph node-positive bladder cancer who are unfit for or who decline adjuvant chemotherapy.

BJU Int. 2014-1-29

[9]
Lymph node density vs. the American Joint Committee on Cancer TNM nodal staging system in node-positive bladder cancer in patients undergoing extended or super-extended pelvic lymphadenectomy.

Urol Oncol. 2017-4

[10]
Lymph node dissection technique is more important than lymph node count in identifying nodal metastases in radical cystectomy patients: a comparative mapping study.

Eur Urol. 2011-7-14

引用本文的文献

[1]
Evaluation of the association between lymph node ratio and long-term survival in patients after surgery for lymph node-positive bladder cancer: a SEER population-based study with external validation.

BMC Cancer. 2025-1-23

[2]
Which lymph node dissection template is optimal for radical cystectomy? A systematic review and Bayesian network meta-analysis.

Front Oncol. 2022-11-25

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