Bretheau D, Ponthieu A
Centre d'Urologie Castellane, Marseille, France.
Urol Int. 1996;57(1):27-31. doi: 10.1159/000282872.
To study the results on survival of radical cystectomy and pelvic lymphadenectomy in bladder cancer with pelvic node metastases in a retrospective study.
Of 248 patients with transitional cell carcinoma of the bladder treated by cystectomy with pelvic lymphadenectomy from 1970 to 1990, 40 (16%; 37 males, 3 females) had pelvic nodal metastases. Fifteen patients had one positive lymph node (stage pN1) and 25 patients had more than one positive node (stage pN2). Preoperative pelvic radiotherapy was realized in 14 patients.
The perioperative mortality rate was 5% and the perioperative morbidity rate 15%. The overall 1- and 5-year survival rates for patients with nodal metastases were, respectively, 42 and 14%. Overall median survival was 9 months (range: 1-288 months). Three patients are still alive with follow-ups of 7, 12 and over 20 years. Kaplan-Meier survival curves revealed no survival advantage for stage pN1 over pN2 disease (p = 0.10). The 5-year survival rate for patients with stage pN1 was 22% with a median of survival of 17 months (range: 1-288 months). The 5-year survival rate for patients with pN2 disease was 8% with a median of survival of 7 months (range: 1-144 months). The cause of the death was tumoral progression in 26 patients (75%) and local recurrence in 3 patients (10%). A preoperative radiotherapy didn't influence survival.
In our experience, radical cystectomy with pelvic lymphadenectomy provided long-term progression-free survival for a few patients with nodal involvement. Efficacious adjuvant therapy has to be found to improve the results.
在一项回顾性研究中，探讨膀胱癌伴盆腔淋巴结转移患者行根治性膀胱切除术及盆腔淋巴结清扫术的生存结果。
1970年至1990年间，248例接受膀胱切除术及盆腔淋巴结清扫术治疗的膀胱移行细胞癌患者中，40例（16%；男性37例，女性3例）有盆腔淋巴结转移。15例患者有1个阳性淋巴结（pN1期），25例患者有1个以上阳性淋巴结（pN2期）。14例患者术前行盆腔放疗。
围手术期死亡率为5%，围手术期发病率为15%。有淋巴结转移患者的1年和5年总生存率分别为42%和14%。总中位生存期为9个月（范围：1 - 288个月）。3例患者仍存活，随访时间分别为7年、12年和20年以上。Kaplan-Meier生存曲线显示，pN1期疾病与pN2期疾病相比无生存优势（p = 0.10）。pN1期患者的5年生存率为22%，中位生存期为17个月（范围：1 - 288个月）。pN2期疾病患者的5年生存率为8%，中位生存期为7个月（范围：1 - 144个月）。26例患者（75%）死于肿瘤进展，3例患者（10%）死于局部复发。术前放疗不影响生存。
根据我们的经验，根治性膀胱切除术及盆腔淋巴结清扫术为少数有淋巴结受累的患者提供了长期无进展生存。必须找到有效的辅助治疗方法以改善结果。
