Department of Urology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, 322100, Zhejiang, People's Republic of China.
Department of Clinical Laboratory, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, 322100, Zhejiang, People's Republic of China.
World J Urol. 2020 Jun;38(6):1579-1585. doi: 10.1007/s00345-019-02788-6. Epub 2019 May 7.
To assess the impact of lymph node dissection (LND) extent on overall survival (OS) and cancer-specific survival (CSS) in patients with pN0M0 renal cell carcinoma (RCC) treated with radical nephrectomy (RN).
Data queried for this study include RCC (2010-2014) from the Surveillance, Epidemiology, and End Results (SEER) program. Kaplan-Meier analyses and multivariate Cox regression models tested the effect of number of removed lymph node (NRN) ≥ 50th percentile on OS and CSS. The associations were evaluated using propensity score (PS) matching adjustment.
A total of 5532 pN0M0 RCC patients were enrolled in our study. The median NRN was 2 (IQR 1-6), the 50th percentile defined patients with NRN ≥ 2. Following PS adjustment, there were no significant differences in clinicopathologic features between two groups of patients except for age. Multivariate model analysis showed that patients with NRN < 2 had worse OS than those with NRN ≥ 2 in pT3 group (HR 1.442; P = 0.032) but not in pT1 and pT2 groups (HR 0.859 and 1.393, P = 0.443 and P = 0.267, respectively). However, patients with NRN < 2 had better CCS than those with NRN ≥ 2 in pT1 group (HR 0.368; P = 0.016) but not in pT2 and pT3 groups (HR 1.674 and 1.325, P = 0.216 and P = 0.176, respectively).
More extensive LND (NRN ≥ 2) at RN is associated with better OS in pT3N0M0 RCC patients while it exerts negative influence on CCS in pT1N0M0 group. Hence, more extensive LND has therapeutic value in pT3 individuals but not in pT1 group.
评估淋巴结清扫术（LND）范围对接受根治性肾切除术（RN）治疗的 pN0M0 肾细胞癌（RCC）患者总生存（OS）和癌症特异性生存（CSS）的影响。
本研究的数据来自监测、流行病学和最终结果（SEER）计划中的 RCC（2010-2014 年）。Kaplan-Meier 分析和多变量 Cox 回归模型测试了移除的淋巴结数量（NRN）≥第 50 个百分位数对 OS 和 CSS 的影响。使用倾向评分（PS）匹配调整评估相关性。
共纳入 5532 例 pN0M0 RCC 患者。NRN 的中位数为 2（IQR 1-6），第 50 个百分位数定义为 NRN≥2 的患者。在 PS 调整后，两组患者的临床病理特征除年龄外无显著差异。多变量模型分析显示，NRN＜2 的患者在 pT3 组的 OS 差于 NRN≥2 的患者（HR 1.442；P=0.032），但在 pT1 和 pT2 组中无显著差异（HR 分别为 0.859 和 1.393，P=0.443 和 P=0.267）。然而，NRN＜2 的患者在 pT1 组的 CSS 优于 NRN≥2 的患者（HR 0.368；P=0.016），但在 pT2 和 pT3 组中无显著差异（HR 分别为 1.674 和 1.325，P=0.216 和 P=0.176）。
在接受 RN 的 pT3N0M0 RCC 患者中，更广泛的 LND（NRN≥2）与 OS 改善相关，而在 pT1N0M0 组中，LND 对 CSS 产生负面影响。因此，更广泛的 LND 在 pT3 个体中有治疗价值，但在 pT1 组中没有。
