Dell'Oglio Paolo, Larcher Alessandro, Muttin Fabio, Di Trapani Ettore, Trevisani Francesco, Ripa Francesco, Carenzi Cristina, Briganti Alberto, Salonia Andrea, Montorsi Francesco, Bertini Roberto, Capitanio Umberto
Unit of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy; Division of Experimental Oncology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy.
Unit of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy; Division of Experimental Oncology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy.
Urol Oncol. 2017 Nov;35(11):662.e9-662.e15. doi: 10.1016/j.urolonc.2017.07.010. Epub 2017 Aug 8.
To assess whether even in the group of localized renal cell carcinoma (RCC), some patients might harbor a disease with a predilection for lymph node invasion (LNI) and/or lymph node (LN) progression and might deserve lymph node dissection (LND) at the time of surgery.
Between 1990 and 2014, 2,010 patients with clinically defined T1-T2N0M0 RCC were treated with nephrectomy and standardized LND at a single tertiary care referral center. The endpoint consists of the presence of LNI and/or nodal progression, defined as the onset of a new clinically detected lymphadenopathy (>10mm) in the retroperitoneal lymphatic area with associated systemic progression or histological confirmation or both. We tested the association between clinical characteristics and the endpoint of interest. Predictors consisted of age at surgery, clinical tumor size, preoperative hemoglobin, and platelets levels. Multivariable logistic regression model and smoothed Lowess method were used.
LNI was recorded in 14 cases (2.2%). The median follow-up after surgery was 68 months. During the study period, 23 patients (1.1%) experienced LN progression; 91% of those patients experienced LN progression within 3 years after surgery. Combining the 2 endpoints, 36 patients (1.8%) had LNI and/or LN progression. Clinical tumor size was the only independent predictors of LNI and/or LN progression (OR = 1.25). A significant increase of the risk of LNI and/or LN progression was observed in RCC larger than 7cm (cT2a or higher).
LNI and/or LN progression is a rare entity in patients with localized RCC. Nonetheless, patients with larger tumors might still benefit from LND because of a non-negligible risk of LNI and/or LN progression.
评估即使在局限性肾细胞癌（RCC）患者群体中，是否有些患者可能患有易发生淋巴结侵犯（LNI）和/或淋巴结（LN）进展的疾病，以及在手术时是否值得进行淋巴结清扫（LND）。
1990年至2014年间，在一家三级医疗转诊中心，对2010例临床诊断为T1-T2N0M0期RCC的患者进行了肾切除术和标准化LND。终点指标包括LNI和/或淋巴结进展，定义为在腹膜后淋巴区域新出现临床检测到的淋巴结病（>10mm），伴有相关的全身进展或组织学证实或两者皆有。我们测试了临床特征与感兴趣的终点指标之间的关联。预测因素包括手术时的年龄、临床肿瘤大小、术前血红蛋白和血小板水平。使用多变量逻辑回归模型和平滑的局部加权散点平滑法（Lowess法）。
记录到14例（2.2%）发生LNI。术后中位随访时间为68个月。在研究期间，23例患者（1.1%）出现LN进展；其中91%的患者在术后3年内出现LN进展。将这两个终点指标合并，36例患者（1.8%）出现LNI和/或LN进展。临床肿瘤大小是LNI和/或LN进展的唯一独立预测因素（OR = 1.25）。在肿瘤大于7cm（cT2a或更高）的RCC患者中，观察到LNI和/或LN进展风险显著增加。
LNI和/或LN进展在局限性RCC患者中是一种罕见情况。尽管如此，由于LNI和/或LN进展的风险不可忽视，肿瘤较大的患者可能仍能从LND中获益。
