Zareba Piotr, Rosenzweig Barak, Winer Andrew G, Coleman Jonathan A
Urology Service, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, New York.
Cancer. 2017 May 15;123(10):1741-1750. doi: 10.1002/cncr.30516. Epub 2017 Feb 2.
Prior studies examining the value of lymph node (LN) dissection (LND) in patients with urothelial carcinoma of the upper urinary tract (UTUC) have produced conflicting results. The objective of the current study was to assess the relationship between LN yield and survival among patients undergoing radical nephroureterectomy (RNU).
The National Cancer Data Base was used to identify patients with non-metastatic UTUC who were treated with RNU between 2004 and 2012. The association between LN yield and overall survival (OS) was assessed using Cox proportional hazards regression, with adjustment for patient, tumor, and facility characteristics.
Of the 14,472 patients, 2926 (20%) underwent LND. The median yield was 2 LNs (interquartile range 1-6 LNs). Among the entire cohort and the LN-negative (pN0) subgroup, a higher LN yield was associated with lower all-cause mortality (multivariable hazard ratio [HR] 0.94 per 5 LNs removed, 95% confidence interval [95% CI] 0.89-1.00 [P = .034] for the entire cohort and HR 0.86, 95% CI 0.79-0.94 [P = .001] for the pN0 subgroup). Among patients with positive LNs (pN+), there was no association noted between LN yield and OS; however, positive and negative LN counts were found to be independent predictors of OS (HR 1.27 per 5 positive LNs, 95% CI 1.16-1.39 [P<.001] and HR 0.90 per 5 negative LNs, 95% CI 0.82-1.00 [P = .049]).
In this large, contemporary cohort of patients with UTUC, LND was found to be used infrequently despite evidence that a higher LN yield is associated with lower all-cause mortality. Cancer 2017;123:1741-1750. © 2017 American Cancer Society.
先前关于上尿路尿路上皮癌（UTUC）患者淋巴结清扫术（LND）价值的研究结果相互矛盾。本研究的目的是评估接受根治性肾输尿管切除术（RNU）患者的淋巴结获取数量与生存率之间的关系。
利用国家癌症数据库识别2004年至2012年间接受RNU治疗的非转移性UTUC患者。使用Cox比例风险回归评估淋巴结获取数量与总生存期（OS）之间的关联，并对患者、肿瘤和机构特征进行校正。
在14472例患者中，2926例（20%）接受了LND。淋巴结获取数量的中位数为2个（四分位间距为1 - 6个）。在整个队列以及淋巴结阴性（pN0）亚组中，淋巴结获取数量越多，全因死亡率越低（整个队列中每切除5个淋巴结的多变量风险比[HR]为0.94，95%置信区间[95%CI]为0.89 - 1.00[P = 0.034]；pN0亚组中HR为0.86，95%CI为0.79 - 0.94[P = 0.001]）。在淋巴结阳性（pN +）的患者中，未发现淋巴结获取数量与OS之间存在关联；然而，阳性和阴性淋巴结数量被发现是OS的独立预测因素（每5个阳性淋巴结的HR为1.27，95%CI为1.16 - 1.39[P < 0.001]；每5个阴性淋巴结的HR为0.90，95%CI为0.82 - 1.00[P = 0.049]）。
在这个大型当代UTUC患者队列中，尽管有证据表明淋巴结获取数量越多全因死亡率越低，但LND的使用并不频繁。《癌症》2017年；123：1741 - 1750。©2017美国癌症协会。
