Department of Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia.
UWA Medical School, University of Western Australia, Perth, Western Australia, Australia.
ANZ J Surg. 2023 Mar;93(3):675-679. doi: 10.1111/ans.18292. Epub 2023 Mar 3.
For patients undergoing radical cystectomy with pelvic lymph node dissection for urothelial cancer, a lymph node count of at least 16 is associated with improved cancer-specific and overall survival. Lymph node yield is presumed to relate directly to extent of dissection and surgical quality, however limited studies have reviewed the impact of the pathological assessment process of lymph nodes on lymph node yield.
A retrospective assessment of 139 patients who had radical cystectomy for urothelial cancer between March 2015 and July 2021 from Fiona Stanley Hospital (Perth, Australia) by a single surgeon was assessed. A change in pathological assessment process from assessment of only palpable lymph nodes to microscopic assessment of the entire submitted specimens occurred in August 2018. Patients were divided into two groups accordingly and other relevant demographic and pathological data was recorded. The impact of pathological processing technique on lymph node yield was assessed using the Student T test and logistical regression was used to assess the impact of other demographic variables.
The mean lymph node yield was 16.2 nodes (IQR 12-23) in 54 patients in the pre-process change group compared to 22.4 nodes (IQR 15-28.4) in 85 patients in the post-process change group (P < 0.0001). 53.7% had 16 or more nodes in the pre-process change group compared to 71.3% in the post-process change group (P = 0.04). Age, BMI, and gender were not significant predictors of lymph node yield.
The current study demonstrates that the microscopic assessment of all lymph node tissue detects significantly more lymph nodes than only examining palpably abnormal tissue. Pathologic assessment protocols should be standardized to this technique to ensure the utility of lymph node yield as a quality metric.
对于接受根治性膀胱切除术和盆腔淋巴结清扫术的尿路上皮癌患者，至少 16 个淋巴结的检出与改善癌症特异性和总体生存率相关。淋巴结检出量被认为与清扫范围和手术质量直接相关，但有限的研究已经审查了淋巴结病理评估过程对淋巴结检出量的影响。
对 2015 年 3 月至 2021 年 7 月期间由一名外科医生在澳大利亚珀斯的 Fiona Stanley 医院进行根治性膀胱切除术的 139 例尿路上皮癌患者进行了回顾性评估。病理评估过程从仅评估可触及的淋巴结改为对整个送检标本进行显微镜评估的变化发生在 2018 年 8 月。患者被相应地分为两组，并记录了其他相关的人口统计学和病理数据。使用学生 t 检验评估病理处理技术对淋巴结检出量的影响，使用逻辑回归评估其他人口统计学变量对淋巴结检出量的影响。
在预处理变化组的 54 例患者中，平均淋巴结检出量为 16.2 个（IQR 12-23），而在处理变化组的 85 例患者中，平均淋巴结检出量为 22.4 个（IQR 15-28.4）（P < 0.0001）。在预处理变化组中，有 53.7%的患者检出 16 个或更多淋巴结，而在处理变化组中，有 71.3%的患者检出 16 个或更多淋巴结（P = 0.04）。年龄、BMI 和性别不是淋巴结检出量的显著预测因素。
本研究表明，对所有淋巴结组织进行显微镜评估比仅检查触诊异常组织可显著检出更多的淋巴结。病理评估方案应标准化为该技术，以确保淋巴结检出量作为质量指标的有效性。
