Packiam Vignesh T, Tsivian Matvey, Boorjian Stephen A
Department of Urology, Mayo Clinic, Rochester, MN, USA.
Transl Androl Urol. 2020 Dec;9(6):3082-3093. doi: 10.21037/tau.2019.06.01.
Radical cystectomy (RC) represents a standard treatment for non-metastatic muscle-invasive and select high-risk non-muscle invasive bladder cancer. Lymphadenectomy performed at time of RC identifies nodal metastases in up to 25% of patients despite normal imaging. There has been an increasing utilization of pelvic lymph node dissection (PLND) with RC since 1950, and in fact lymph node dissection is now recommended in contemporary National Comprehensive Cancer Network (NCCN) guidelines. Benefits of removing of nodal disease include improved staging, guidance for adjuvant treatment, and potentially improved oncologic outcomes. Advantages of dissection have been suggested among both node-negative and node-positive patients. Numerous studies have attempted to define the optimal dissection characteristics of lymphadenectomy with regard to nodal yield and anatomic boundaries of dissection. The ideal extent of lymphadenectomy remains uncertain due to the retrospective and non-randomized nature of the majority of existing reports, which are thereby limited by significant confounding and selection bias. Two randomized controlled trials have investigated this issue, one of which LEA AUO AB 25/02 recently reported its outcomes, demonstrating no significant improvement in 5-year outcomes with an extended dissection. Meanwhile, the Southwest Oncology Group 1011 trial has completed enrollment and data are maturing. While current data preclude definitive recommendations, herein we review the why, when, and how to perform a PLND for bladder cancer.
根治性膀胱切除术（RC）是治疗非转移性肌层浸润性膀胱癌和部分高危非肌层浸润性膀胱癌的标准方法。尽管影像学检查结果正常，但在RC手术时进行淋巴结清扫可发现高达25%的患者存在淋巴结转移。自1950年以来，RC手术中盆腔淋巴结清扫（PLND）的应用越来越多，事实上，当代美国国立综合癌症网络（NCCN）指南现已推荐进行淋巴结清扫。切除淋巴结疾病的益处包括改善分期、指导辅助治疗以及可能改善肿瘤学结局。在淋巴结阴性和阳性患者中均已显示出清扫的优势。许多研究试图确定淋巴结清扫在淋巴结获取量和清扫解剖边界方面的最佳清扫特征。由于大多数现有报告具有回顾性和非随机性质，因此理想的淋巴结清扫范围仍不确定，这些报告因此受到显著混杂因素和选择偏倚的限制。两项随机对照试验对这一问题进行了研究，其中一项试验LEA AUO AB 25/02最近报告了其结果，显示扩大清扫在5年结局方面无显著改善。与此同时，西南肿瘤协作组1011试验已完成入组，数据正在成熟。虽然目前的数据无法给出明确建议，但在此我们将对膀胱癌PLND的原因、时机和方法进行综述。
