Liu Nick W, Murray Katie S, Donat S Machele, Herr Harry W, Bochner Bernard H, Dalbagni Guido
Department of Urology, SUNY Upstate Medical University, Syracuse, NY, USA.
Department of Surgery, Urology Division, University of Missouri School of Medicine, Columbia, MO, USA.
Bladder Cancer. 2019 Jan 31;5(1):13-19. doi: 10.3233/BLC-180186.
While a definitive cure can be achieved by radical cystectomy and pelvic lymph node dissection in select patients with regional lymphadenopathy, the benefit remains uncertain in patients who present with non-regional metastases. We analyzed the survival outcomes of post-chemotherapy retroperitoneal lymph node dissection.
We reviewed our institutional database and identified 13 patients with radiographically evident or biopsy proven retroperitoneal nodal metastases with a significant response to chemotherapy. These patients underwent consolidative surgery with concomitant or delayed retroperitoneal lymph node dissection. The primary endpoints were progression-free survival and disease-specific survival from the time of retroperitoneal lymph node dissection.
All patients had primary urothelial cell carcinoma. Twelve patients underwent concomitant radical cystectomy, pelvic and retroperitoneal lymph node dissection. Seven patients (54%) had residual disease in the retroperitoneum and the median number of retroperitoneal nodes containing metastases was 4 (IQR 2-6). Six (86%) developed disease recurrences within 2 years of surgery and 5 (71%) died of cancer. Of the 6 patients without residual disease in the retroperitoneum, 2 (33%) developed recurrences and died of disease progression. The 2-year disease-specific survival was worse for patients with residual disease in the retroperitoneum than those without residual retroperitoneal disease (34%, 95% CI 5-68 vs 50%, 95% CI 6-85).
The presence of retroperitoneal nodal metastases at post-chemotherapy retroperitoneal lymph node dissection is a poor prognosticator. Consolidative surgery with retroperitoneal lymph node dissection provides important prognostic information and may be therapeutic in a very small subset of these patients.
对于部分伴有区域淋巴结肿大的患者，根治性膀胱切除术和盆腔淋巴结清扫术可实现根治，但对于出现非区域转移的患者，其获益仍不明确。我们分析了化疗后腹膜后淋巴结清扫术的生存结果。
我们回顾了机构数据库，确定了13例经影像学检查明确或活检证实有腹膜后淋巴结转移且对化疗有显著反应的患者。这些患者接受了巩固性手术，同时或延迟进行腹膜后淋巴结清扫术。主要终点是从腹膜后淋巴结清扫术时起的无进展生存期和疾病特异性生存期。
所有患者均为原发性尿路上皮癌。12例患者接受了同期根治性膀胱切除术、盆腔和腹膜后淋巴结清扫术。7例（54%）患者腹膜后有残留病灶，腹膜后有转移的淋巴结中位数为4个（四分位间距2 - 6）。6例（86%）患者在术后2年内出现疾病复发，5例（71%）死于癌症。在腹膜后无残留病灶的6例患者中，2例（33%）出现复发并死于疾病进展。腹膜后有残留病灶的患者2年疾病特异性生存率低于腹膜后无残留病灶的患者（34%，95%可信区间5 - 68 vs 50%，95%可信区间6 - 85）。
化疗后腹膜后淋巴结清扫术时存在腹膜后淋巴结转移预后较差。腹膜后淋巴结清扫术的巩固性手术可提供重要的预后信息，对极少数这类患者可能具有治疗作用。
