Wiener E S, Lawrence W, Hays D, Lobe T E, Andrassy R, Donaldson S, Crist W, Newton W, Johnson J, Gehan E
Children's Hospital of Pittsburgh, Department of Pediatric Surgery, PA 15213.
J Pediatr Surg. 1994 Feb;29(2):171-7; discussion 178. doi: 10.1016/0022-3468(94)90313-1.
Retroperitoneal lymph node dissection (RPLND) was used in 121 Intergroup Rhabdomyosarcoma Study (IRS) III patients with nonmetastatic paratesticular (PT) rhabdomyosarcoma (RMS) to assess retroperitoneal lymph node (RPLN) involvement so as to determine the need for x-ray therapy (XRT). Clinical node evaluation (CNE) was accomplished by a computed tomography (CT) scan in 105 and a sonogram in six. Pathological node evaluation (PNE) was performed in 113: lymphadenectomy (9 bilateral, 85 unilateral) and biopsy in 19. Vincristine and actinomycin D were used for 1 year postoperatively in 89%; all patients who had positive PNE received RPLN XRT. This study compares CNE with PNE and evaluates predictors of relapse and survival.
There were clinically negative nodes (cN0) in 81% of the 121 patients. Among cN0 patients, 14% had positive nodes (pN1). Of the clinically positive (cN1) patients, 94% had pN1. RPLN relapse occurred in only two of the 121 patients. Initially both had cN0 and one had PNE that was negative. For all 121 patients, the 5-year survival was 91%. For cN0 patients, the 5-year survival was 96% compared with 69% for cN1 patients (P < .001). Among the children in whom treatment failed, nodes were cN1 in 5 of 11 (45%) compared with 15 of 107 (14%) in those whose treatment did not fail (P < .008).
(1) Results of RPLN imaging studies were negative in 81% of patients with PT RMS (specificity 99%, sensitivity 57%). (2) RPLN recurrence is uncommon (even when RPLN are initially involved) if regional XRT and appropriate chemotherapy are used.(ABSTRACT TRUNCATED AT 250 WORDS)
121例参加横纹肌肉瘤研究组（IRS）III期试验的非转移性睾丸旁（PT）横纹肌肉瘤（RMS）患者接受了腹膜后淋巴结清扫术（RPLND），以评估腹膜后淋巴结（RPLN）受累情况，从而确定是否需要进行放疗（XRT）。105例患者通过计算机断层扫描（CT）进行临床淋巴结评估（CNE），6例通过超声检查。113例患者进行了病理淋巴结评估（PNE）：9例双侧淋巴结清扫，85例单侧淋巴结清扫，19例活检。89%的患者术后使用长春新碱和放线菌素D 1年；所有PNE阳性的患者均接受了RPLN区域放疗。本研究比较了CNE和PNE，并评估了复发和生存的预测因素。
121例患者中81%临床淋巴结阴性（cN0）。在cN0患者中，14%有阳性淋巴结（pN1）。临床阳性（cN1）患者中，94%有pN1。121例患者中仅2例发生RPLN复发。最初这2例均为cN0，其中1例PNE为阴性。121例患者的5年生存率为91%。cN0患者的5年生存率为96%，而cN1患者为69%（P < 0.001）。在治疗失败的儿童中，11例中有5例（45%）为cN1，而治疗未失败的107例中有15例（14%）为cN1（P < 0.008）。
（1）PT RMS患者中81%的RPLN影像学检查结果为阴性（特异性99%，敏感性57%）。（2）如果采用区域放疗和适当的化疗，RPLN复发并不常见（即使RPLN最初受累）。（摘要截断于250字）
