根治性膀胱切除术中扩大淋巴结清扫与标准淋巴结清扫的疗效与预后生存分析比较

王文宽; 王明帅; 宋黎明; 瓦斯里江·瓦哈甫; 杨飞亚; 邢念增

doi:10.13201/j.issn.1001-1420.2018.11.004

根治性膀胱切除术中扩大淋巴结清扫与标准淋巴结清扫的疗效与预后生存分析比较

- 1. 首都医科大学附属北京朝阳医院泌尿外科(北京, 100006);
- 2. 中国医学科学院肿瘤医院泌尿外科
基金项目:
北京市首都科技领导人才项目 (编号Z181100006318007)

详细信息

通讯作者: 邢念增,E-mail:nianzeng2006@vip.sina.com

中图分类号: R737.14

收稿日期: 2018-09-20

Comparison of the efficacy and prognosis of survival between expanded lymph node dissection and standard lymph node dissection in radical cystectomy

- 1. Department of Urology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100006, China;
- 2. Department of Urology, Cancer Hospital Chinese Academy of Medical Sciences

More Information

Corresponding author: XING Nianzeng, E-mail: nianzeng2006@vip.sina.com

Received Date: 20 September 2018

摘要

摘要: 目的:比较根治性膀胱切除术(RC)中扩大淋巴结清扫(ePLND)与标准淋巴结清扫(sPLND)的临床疗效与患者预后生存,以选择更合理的手术方式。方法:回顾性分析2004年3月~2016年11月在我院行RC的尿路上皮癌患者的临床及随访资料,其中ePLND组41例,sPLND组128例。对两组患者的术后病理结果、无复发生存率(RFS)、肿瘤特异性生存率(CSS)及总生存率(OS)等进行分析比较。结果:169例手术均顺利完成,无围手术期死亡发生。两组患者术前一般资料比较差异均无统计学意义(P>0.05)。ePLND组的淋巴结清扫数目[(23.0±6.8)个vs.(11.0±5.2)个,P<0.01]、淋巴结密度(8.49% vs.3.50%,P<0.01)及淋巴结阳性患者比例(34.15% vs.18.75%,P=0.04)均高于sPLND组。ePLND组和sPLND组中位随访时间分别为49.5个月和95.5个月,Kaplan-Meier单因素生存分析显示在各T分期亚组及N分期亚组中,两组患者的RFS、CSS及OS差异均无统计学意义(P>0.05)。在<T₂期患者中,清扫数目多(≥ 14个)的患者RFS明显好于清扫数目少(<14个)的患者(P<0.05)。Cox多因素分析显示淋巴结清扫范围对患者的生存率虽无明显影响,但有提高患者CSS的趋势(P=0.079)。结论:在RC术中,ePLND可以清扫更多的淋巴结,阳性淋巴结检出率更高。相较于sPLND,ePLND有提升患者CSS的趋势。
- 根治性膀胱切除术 /
- 扩大淋巴结清扫 /
- 标准淋巴结清扫 /
- 生存率
Abstract: Objective: To compare the efficacy and prognosis of survival between expanded lymph node dissection (ePLND) and standard lymph node dissection (sPLND) in radical cystectomy (RC) from one center, in order to choose a more reasonable operation method.Method: We retrospectively analysed patients' clinical and followup data who were diagnosed with urothelial carcinoma and underwent RC in our hospital from March 2004 to November 2016, of whom 41 cases underwent ePLND and 128 cases underwent sPLND.The postoperative pathological results, recurrence free survival (RFS), cancer specific survival (CSS) and overal survival (OS) of the two groups were compared and analyzed.Result: All 169 cases were successfully operated and no perioperative deaths occurred.There was no statistical difference in preoperative general data between the two groups.The number of lymph node dissection[(23.0±6.8) vs. (11.0±5.2), P<0.01], lymph node density (8.49%vs.3.50%, P<0.01) and proportion of lymph node positive patients (34.15% vs.18.75%, P=0.04) in ePLND group were all higher than those in sPLND group.The median follow-up time in ePLND group and sPLND group was 49.5 and 95.5 months, respectively.Kaplan-meier univariate analysis showed that there was no statistically difference in RFS, CSS and OS between the two groups in the T staging subgroup and N staging subgroup (P>0.05).In patients with<T₂ stage, RFS of the group with more dissection (≥ 14) was significantly better than that of the group with less dissection (<14) (P<0.05).Cox multivariate analysis showed that although the extent of lymph node dissection had no significant effect on the survival of patients, there was a tendency to improve the CSS (P=0.079).Conclusion: In RC, ePLND can dissect more lymph nodes, positive lymph node detection rate is higher compared with sPLND, ePLND has a tendency to improve CSS in patients.
- radical cystectomy /
- expanded lymph node dissection /
- standard lymph node dissection /
- survival

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