盆腔淋巴结清扫对评估膀胱癌预后的价值

Prognostic significance of pelvic lymphadenectomy in patients with bladder cancer

目的:评价规范化盆腔淋巴结清扫对膀胱癌患者预后的影响作用,分析影响淋巴结转移的相关因素及淋巴结肿大与淋巴结转移两者的关系。方法:回顾性分析2008年1月至2013年7月天津医科大学肿瘤医院120例膀胱癌患者临床资料,分为盆腔淋巴结规范化清扫组58例,未规范化清扫组62例。分析淋巴结转移与病理分期、分级及术中触及肿大淋巴结的关系,探讨盆腔淋巴结清扫对预后的影响。结果:120例膀胱癌患者术后1、3、5年总生存率分别为84.0%、69.9%、57.9%。规范化盆腔淋巴结清扫组与未规范化清扫组的3年生存率分别为78.4%与46.2%(χ2=5.487,P=0.019)。淋巴结阳性与阴性患者术后3年生存率分别为50.0%与86.4%,(χ2=9.303,P=0.002)。术中触及肿大淋巴结与淋巴结转移具有相关性(P<0.001),病理分期、病理类型(尿路上皮癌及非尿路上皮癌)及年龄是患者预后的影响因素(P<0.05)。结论:术中触及肿大淋巴结与淋巴结转移相关,可预测淋巴结转移的发生,盆腔淋巴结清扫影响膀胱癌患者预后,阳性淋巴结是膀胱癌患者预后的独立危险因素,规范盆腔淋巴结清扫术可延长患者术后生存时间。

Objective：To evaluate the prognostic significance of standard pelvic lymphadenectomy on the disease-free survival （DFS） rate of bladder cancer patients undergoing radical cystectomy （RC） and to discuss the influencing factors of lymph node positivity and the relationship between positive lymph nodes and lymphadenectasis. Methods：This prospective analysis includes 120 cases of bladder cancer treated with pelvic lymphadenectomy and RC in Tianjin Medical University Cancer Institute and Hospital between 2008 and 2013. The cases were divided into two groups, namely, the standard pelvic lymphadenectomy group （Group A） and the nonstandard pelvic lymphadenectomy group （Group B）. The relationships among positive lymph nodes, lymphadenectasis, tumor stage, and patho-logical grade were retrospectively analyzed. Results：The 1-, 3-, and 5-year overall survival rates of 120 patients were 84%, 69.9%, and 57.9%, respectively. Group A was significantly correlated with a better 3-year overall survival rate than Group B, i.e., 78.4%vs. 46.2%（P〈0.05）. Lymphadenectasis influenced the DFS rate of bladder cancer patients after RC with pelvic lymphadenectomy, i.e., 50.0%vs. 86.4%（χ^2=9.303, P〈0.05）. Meanwhile, lymphadenectasis was positively correlated with lymph node positivity （P〈0.001）. Tumor stage, histological subtype （urothelial carcinoma and non-urothelial carcinoma）, and age were the prognostic factors for bladder cancer （P〈0.05）. Conclusion：Intraoperative lymphadenectasis is the influencing factor of lymph node positivity. This study determined that standard pel-vic lymphadenectomy and lymphadenectasis may influence the DFS rate after RC and are the independent risk factors for the prognosis of bladder cancer. Creating evidence-based guidelines of standardized lymphadenectomy for further improvement of the surgical quali-ty and survival of bladder cancer patients is essential.