根治性膀胱切除结合淋巴结扩大清扫术治疗膀胱癌的临床意义

Clinical significance of radical cystectomy with extended lymphadenectomy

目的:分析浸润性膀胱癌行根治性膀胱切除结合盆腔以及腹膜后淋巴结扩大清扫患者的预后情况及相关影响因素。方法:回顾研究2006年1月至2010年12月于北京大学第一医院泌尿外科接受膀胱根治性切除术同时进行淋巴结扩大清扫的32个连续病例的临床资料和随访结果,分析行淋巴扩大清扫患者的预后情况,以及分级、分期、淋巴结情况等可能相关影响因素与患者预后的关系。结果:32例术前活检(或者经尿道电切术,trans ure-thral resection)病理诊断为膀胱浸润移行细胞癌的患者,在随访中,肿瘤进展6例(18.8%,6/32),死亡4例(12.5%,4/32),总体生存率为87.5%(28/32)。32例病例中,17个月、3年生存率分别为(88.7±12.1)%(20/23)、(81.8±17.0)%(14/16)。从病理分级上看,G2级6例,G3级26例,其中死亡病例均为G3级,G3级3年生存率为74.6±23.9%(7/11)(肿瘤分级的不同水平检验生存分析等同性P>0.05)。从病理分期分析,T1、T2分期没有随访期内的死亡事件,T3期17个月生存率为(60.0±42.9)%(3/5),T4期8个月生存率为(87.5±22.9)%(7/8)(肿瘤分期的不同水平检验生存分析等同性P<0.05)。32例中淋巴结阳性9例(28.1%,9/32),阴性23例(71.9%,23/32),平均清扫淋巴结数目22.8个。淋巴结阳性患者17个月生存率(50.0±44.6)%(3/5),淋巴结阴性患者3年生存率(92.3±14.5)%(12/13)(淋巴结不同水平检验生存分析等同性P<0.05)。淋巴结密度小于20%患者3年生存率(88.8±15.4)%(12/14),大于20%患者8个月生存率(66.7±53.3)%(2/3)(淋巴结密度不同水平检验生存分析等同性P<0.05)。结论:行根治性膀胱切除结合盆腔及腹膜后淋巴结扩大清扫可以有效改善浸润性膀胱癌患者预后;肿瘤分期、淋巴结状况及淋巴结密度与预后生存密切相关。

Objective： To evaluate the prognosis of patients treated with radical cystectomy and exten-ded lymphadenectomy for invasive bladder cancer and to describe the association of the primary bladder tumor grade,stage,lymph node status and lymph node density with clinical outcomes.Methods： A retrospective analysis was done of 32 consecutive cases with bladder cancer who received radical cystectomy and extended lymph node dissection from January 2006 to December 2010 in the Department of Urology,Peking University First Hospital.All the patients were scheduled for the follow-up.The survival data were analyzed with the tumor grade,stage,lymph node status and other factors that might relate to the prognosis by statistics.Results： All the cases were diagnosed as invasive urothelial bladder cancer by preoperative biopsy or TUR-Bt.During the follow-up,6 patients（18.8%） got disease progression,and 4 patients died（12.5%）.Overall survival rate was 87.5%.In 32 patients,17 months and 3 year survival rates were（88.7 ± 12.1）% and（81.8 ± 17.0）%,respectively.From the tumor grade point of view,6 patients belonged to G2,and 26 cases G3.All deaths were graded G3.G3-class 3-year survival rate was（74.6 ± 23.9）%（P 0.05,compared with G2）.From the analysis of stage,T1 and T2 stages had no death during the follow-up.The 17-month survival rate of T3 group was（60.0 ± 42.9）%,the 8-month survival rate of T4 group was（87.5 ± 22.9）%.There were 9 patients with po-sitive lymph nodes（28.1%） and 23 with negative in（71.9%）.The number of dissection lymph nodes was from 7-50（average 22.8）.The 17-month survival rate of patients with positive lymph node was（50.0 ± 44.6）%.The 3-year survival rate of patients with negative lymph node was（92.3 ± 14.5）%（P0.05）.The 3-year survival rate of patients with lymph node density less than 20% was（88.8 ± 15.4）%.The 8-month survival rate of patients with lymph node density greater than 20% was（66.7 ± 53.3）%（P0.05）.Conclusion： Radical cystectomy with extended lymph node dissection can improve the prognosis of patients with invasive bladder cancer.Tumor stage,lymph node status and lymph node density are closely related to the patient＇s survival.