Rosenblatt Robert, Johansson Markus, Alamdari Farhood, Sidiki Alexander, Holmström Benny, Hansson Johan, Vasko Janos, Marits Per, Gabrielsson Susanne, Riklund Katrine, Winqvist Ola, Sherif Amir
Department of Urology, Stockholm South General Hospital, Karolinska Institutet, Stockholm, Sweden.
Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, 901 85, Umeå, Sweden.
World J Urol. 2017 Jun;35(6):921-927. doi: 10.1007/s00345-016-1952-x. Epub 2016 Oct 13.
To determine whether sentinel node detection (SNd) in muscle-invasive urothelial bladder cancer (MIBC) can be performed in patients undergoing neoadjuvant chemotherapy (NAC) and determine whether SNd is feasible in all pT stages, including pT0.
Previous published series of SNd in MIBC have not included patients undergoing NAC, and systematic reports of pT0 patients w/wo NAC were absent. Translational immunological tumor research on MIBC focusing on SNd, in the era of NAC, requires technical feasibility. Additionally, SNd in MIBC requests further evaluations as a method for nodal staging.
Ninety-nine patients with suspected urothelial MIBC were prospectively selected from six urological centers. After TUR-B and primary staging, 65 MIBC patients qualified for radical cystectomy. Precystectomy staging was cT2a-T4aN0M0, including 47 NAC patients and 18 chemo-naïve patients. All 65 patients underwent intraoperative SNd by peritumoral injection of 80 Mbq Technetium and Geiger probe detection. Postcystectomy staging was pT0-T4aN0-N2M0. SNs were defined by two calculations, SNdef1 and SNdef2.
Totally 1063 lymph nodes were removed (total SNs; 222-227). NAC patients with pT0 (n = 24) displayed a true positive detection in 91.7 % by either SNdef, with a median of 3.0 SNs. NACpT >0 patients had a true positive detection in 87 % (SNdef1) and 91.3 % (SNdef2). In a univariate analysis, patient group neither NAC nor tumor downstaging influenced detection rates, regardless of SN definition. In total eight patients, 4/22 metastatic nodes were SNs while 18/22 were non-SNs.
Sentinel node detection in MIBC is feasible also in NAC patients, regardless of pT stage. SNd played no role in nodal staging.
确定在接受新辅助化疗（NAC）的肌层浸润性尿路上皮膀胱癌（MIBC）患者中是否可以进行前哨淋巴结检测（SNd），并确定SNd在包括pT0在内的所有pT分期中是否可行。
既往发表的关于MIBC中SNd的系列研究未纳入接受NAC的患者，且缺乏对接受或未接受NAC的pT0患者的系统报道。在NAC时代，聚焦于SNd的MIBC转化性免疫肿瘤学研究需要技术可行性。此外，MIBC中的SNd作为一种淋巴结分期方法需要进一步评估。
从六个泌尿外科中心前瞻性选取99例疑似尿路上皮MIBC患者。经尿道膀胱肿瘤电切术（TUR-B）和初步分期后，65例MIBC患者符合根治性膀胱切除术条件。膀胱切除术前分期为cT2a-T4aN0M0，包括47例接受NAC的患者和18例未接受化疗的患者。所有65例患者均通过瘤周注射80MBq锝和盖革探头检测进行术中SNd。膀胱切除术后分期为pT0-T4aN0-N2M0。前哨淋巴结通过两种计算方法定义，即SNdef1和SNdef2。
共切除1063个淋巴结（总前哨淋巴结；222-227个）。pT0的NAC患者（n = 24）通过任一SNdef定义的真阳性检测率为91.7%，前哨淋巴结中位数为3.0个。NAC pT>0的患者真阳性检测率为87%（SNdef1）和91.3%（SNdef2）。单因素分析显示，无论是否接受NAC以及肿瘤降期情况如何，患者组均不影响检测率，与前哨淋巴结定义无关。总共8例患者中，22个转移淋巴结中有4个是前哨淋巴结，18个是非前哨淋巴结。
无论pT分期如何，MIBC中的前哨淋巴结检测在接受NAC的患者中也是可行的。前哨淋巴结检测在淋巴结分期中不起作用。
