Effect of the number of negative lymph nodes on prognosis of patients with muscle-invasive bladder cancer
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摘要: 目的 探讨肌层浸润性膀胱癌(muscle-invasive bladder cancer, MIBC)患者阴性淋巴结数量对预后的影响。方法 回顾性分析厦门大学附属东南医院2015年1月-2020年6月年收治73例接受膀胱根治性切除术的MIBC患者临床病理资料, 根据术后是否发生肿瘤复发或死亡分为预后不良组(32例)和预后良好组(41例)。根据术后病理结果计算患者阴性淋巴结总数, 绘制受试者工作特征(receiver operating characteristic, ROC)曲线分析阴性淋巴结数对预后的预测作用, 单因素和logistic多因素分析MIBC患者预后影响因素, 采用Kaplan-Meier风险曲线分析阴性淋巴结数对无复发生存期(recurrence free survival, RFS)和总生存期(overall survival, OS)的影响。结果 73例MIBC患者中, 32例肿瘤复发, 复发率43.84%, 复发时间4~35个月, 平均22.72个月; 25例死亡, 死亡率34.25%, 死亡时间8~36个月, 平均25.68个月。单因素分析发现肿瘤最大长径≥3 cm、临床分期Ⅲ~Ⅳ期、淋巴结转移、清扫淋巴结数量 < 23枚、阴性淋巴结数量 < 18枚与MIBC预后不良相关(P < 0.05)。多因素分析发现肿瘤最大长径≥3 cm (OR=9.125, 95%CI: 1.987~14.371)、临床分期Ⅲ~Ⅳ期(OR=8.377, 95%CI: 1.965~12.752)、清扫淋巴结数量 < 23枚(OR=16.346, 95%CI: 5.081~28.646)、阴性淋巴结数量 < 18枚(OR=22.043, 95%CI: 5.625~44.245)是MIBC预后不良的独立危险因素。Kaplan-Meier分析结果显示, 阴性淋巴结数量 < 18枚患者RFS短于阴性淋巴结数量≥18枚患者(χ2=37.610, P < 0.001), 阴性淋巴结数量 < 18枚患者OS短于阴性淋巴结数量≥18枚患者(χ2=26.690, P < 0.001)。结论 阴性淋巴结数量 < 18枚是MIBC患者预后不良的危险因素, 对患者预后具有预测价值, 可以作为临床预后评估指标。Abstract: Objective To investigate the effect of the number of negative lymph nodes on the prognosis of patients with muscle-invasive bladder cancer (MIBC).Methods The clinicopathological data of 73 MIBC patients who were admitted to the Dongnan Hospital of Xiamen University and underwent radical cystectomy from January 2015 to June 2020 were retrospectively analyzed.The patients were divided into poor prognosis group (n=32) and good prognosis group (n=41) according to whether tumor recurrence or death occurred after surgery.The total number of negative lymph nodes was calculated according to postoperative pathological results, then the ROC curve was drawn to analyze the predictive effect of negative lymph nodes on prognosis.Univariate and logistic multivariate analysis were used to analyze prognostic factors in MIBC patients.The effects of the number of negative lymph nodes on recurrence free survival (RFS) and overall survival (OS) were analyzed by Kaplan-Meier risk curve.Results Among the 73 patients with MIBC, 32 cases had tumor recurrence, and the recurrence rate was 43.84%.The recurrence time was 4-35 months, with an average of 22.72 months.Twenty-five cases died, and the mortality rate was 34.25%.The death time was 8-36(mean 25.68) months.Univariate analysis showed that the maximum length of tumor ≥3 cm, clinical stage Ⅲ-Ⅳ, lymph node metastasis, the number of lymph nodes dissected < 23, the number of negative lymph nodes < 18 were associated with poor prognosis of MIBC (P < 0.05).Multivariate analysis showed that the maximum length and diameter of the tumor ≥3 cm (OR=9.125, 95%CI: 1.987-14.371), clinical stage Ⅲ-Ⅳ(OR=8.377, 95%CI: 1.965-12.752), the number of lymph nodes dissected < 23(OR=16.346, 95%CI: 5.081-28.646), the number of negative lymph nodes < 18(OR=22.043, 95%CI: 5.625-44.245) were independent risk factors in poor prognosis of MIBC.Kaplan-Meier analysis showed that RFS of patients with negative lymph nodes < 18 were shorter than that of patients with negative lymph nodes ≥18(χ2=37.610, P < 0.001), and OS of patients with negative lymph nodes < 18 was shorter than that of patients with negative lymph nodes ≥ 18(χ2=26.690, P < 0.001).Conclusion The number of negative lymph nodes less than 18 is a risk factor in poor prognosis in patients with MIBC, which has predictive value for patients'prognosis and can be used as an indicator for clinical prognosis evaluation.
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Key words:
- number of negative lymph nodes /
- bladder cancer /
- lymph nodes /
- radical cystectomy /
- prognosis /
- recurrence
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表 1 73例MIBC患者预后单因素分析
例，X±S 因素 预后不良组
(32例)预后良好组
(41例)t/χ2 P值 年龄/岁 62.25±5.30 62.21± 4.56 0.026 0.979 性别 0.139 0.723 男 28 37 女 4 4 BMI/(kg/m2) 23.55±0.44 23.71± 0.42 -1.606 0.113 糖尿病 0.603 0.437 是 6 5 否 26 36 高血压 0.692 0.406 是 8 7 否 24 34 吸烟 0.064 0.800 是 17 23 否 15 18 肾积水 2.924 0.087 是 12 8 否 20 33 手术方式 0.088 0.767 开腹 12 14 腹腔镜 20 27 肿瘤最大长径/cm 9.017 0.003 ≥3 17 8 < 3 15 33 肿瘤分化 0.015 0.902 低分化 9 11 中高分化 23 30 病理类型 0.575 0.448 高级别 12 19 低级别 20 22 临床分期 5.059 0.024 Ⅲ~Ⅳ期 15 9 Ⅱ期 17 32 肿瘤个数 0.486 0.486 多发 11 11 单发 21 30 淋巴结转移 7.136 0.008 是 21 14 否 11 27 清扫淋巴结数量/枚 35.718 < 0.001 < 23 28 7 ≥23 4 34 阴性淋巴结数量/枚 30.122 < 0.001 < 18 22 3 ≥18 10 38 
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表 2 73例MIBC患者预后多因素分析
因素 β SE Wald χ2 OR 95%CI P值 肿瘤最大长径≥3 cm 2.211 1.135 3.796 9.125 1.987~14.371 0.041 临床分期Ⅲ~Ⅳ期 2.126 1.103 3.714 8.377 1.965~12.752 0.044 淋巴结转移 1.907 1.450 1.729 6.733 0.909~12.548 0.189 清扫淋巴结数量 < 23枚 2.794 1.106 6.381 16.346 5.081~28.646 0.001 阴性淋巴结数量 < 18枚 3.093 1.718 3.241 22.043 5.625~44.245 0.003
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