J Urol:非肌层浸润性膀胱癌中,淋巴结切除术是否能够改善根治性膀胱切除术的治疗效果?

2021-11-24 AlexYang MedSci原创

评估了NMIBC的RC期间,LND与局部盆腔无复发生存(LPRS)、癌症特异性生存(CSS)和总生存(OS)之间的关系。

美国泌尿外科协会(AUA)、国家综合癌症网络(NCCN)和欧洲泌尿外科协会(EAU)指南建议,在根治性膀胱切除术(RC)期间,对肌层浸润性膀胱癌(MIBC)患者至少进行标准模板的淋巴结清扫。该建议具有强有力的回顾性证据的支持。证据表明,在MIBC的根治性膀胱切除术中进行LND是有肿瘤学益处的。此外,两项随机试验也进一步确定了MIBC根治术中LND的最佳解剖学模板。

肌层浸润性膀胱癌(MIBC)根治性膀胱切除术(RC)中的淋巴结清扫(LND)已有广泛的研究,但在非肌层浸润性膀胱癌(NMIBC)中,LND作用仍了解的不是特别清楚。

近期,来自美国的研究人员在《J Urol》上发表文章,评估了NMIBC的RC期间,LND与局部盆腔无复发生存(LPRS)、癌症特异性生存(CSS)和总生存(OS)之间的关系

研究人员在三个大型三级转诊中心中,对接受RC治疗的NMIBC患者进行了多机构的回顾性研究。为了优化LPRS、CSS和OS,研究人员确定了淋巴结产量(LNY)的阈值,并为每个可能的LNY阈值建立了单独的Cox回归模型。模型的性能包括Q统计量和危险比(HR),并用来确定最佳的LNY阈值。

共有1647名NMIBC患者接受了RC治疗,中位LNY为15(四分位数为9,23)。模型的性能曲线建议优化LPRS和CSS/OS的LNY为10和20。在多变量回归中,与LNY≤10相比,LNY>10与较低的LPR风险有关(HR 0.63,95% CI 0.42-0.93,p=0.02)。同样,与LNY≤20相比,LNY>20与CSS(HR 0.67,95% CI 0.52-0.87, p=0.002)和OS(HR 0.75,95% CI 0.64-0.88, p<0.001)的改善有关。另外,研究人员在cT1和cTis亚组中也观察到类似的结果。

局部盆腔无复发生存的比较

综上所述,在NMIBC的RC过程中,更大程度的LND与LPRS、CSS和OS的改善有关。因此,他们的结果支持在NMIBC患者的RC过程中纳入LND,特别是在cTis或cT1疾病患者中。另外,未来的前瞻性研究需要评估NMIBC中,LND的理想解剖学模板。

原始出处:

Abhinav Khanna, Tanner Miest, Vidit Sharma et al. Role of Lymphadenectomy During Radical Cystectomy for Non-muscle Invasive Bladder Cancer: Results From a Multi-Institutional Experience. J Urol. Oct 2021

 

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  5. 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    2021-11-25 sodoo
  6. 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    2021-11-25 jeanqiuqiu
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    2021-11-24 tracy117

    积分

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