共查询到20条相似文献，搜索用时 156 毫秒
1.
Chao YK Liu HP Hsieh MJ Wu YC Liu YH Yeh CH Chang HK Tseng CK 《Annals of surgical oncology》2012,19(11):3500-3505
Background
Extensive lymph node dissection (LND) is beneficial in primarily resected esophageal cancer patients. Such benefit was believed to be seen in neoadjuvant chemoradiotherapy (CRT)-treated patients, but evidence was inconsistent. We hypothesized that CRT might offset the benefit of LND in certain subgroup of patients, especially in major responders.Methods
The clinical pathological data and survival of esophageal squamous cell carcinoma patients who received curative resection after CRT between 1996 and 2007 were analyzed. On the basis of the mean LND number of the cohort, patients were divided into two groups: group 1, lower LND, and group 2, higher LND.Results
The cohort comprised 303 patients (295 men and 8 women) with a mean age of 55.4?years. There were 179 patients in group 1 and 124 patients in group 2. One hundred one patients had pathological complete response (pCR). There were more pCR in group 1 (38 vs. 26.6?%, P?=?0.039) and more lymph node positive cases in group 2 (16 vs. 27.4?%, P?=?0.018). Extent of LND had no survival difference in the entire cohort (overall survival 32 vs. 38?%, P?=?0.31). With the stratification analysis according to tumor response, inadequate LND exhibited negative impact in patients who did not experience pCR (P?=?0.027). Without adequate LND, the survival of ypTxN0 was equally poor as ypN-positive cases (overall survival 15 vs. 16?%, P?=?0.791). In the pCR group, the extent of LND had an impact on survival.Conclusions
The effect of LND was influenced by tumor response after CRT. There is a strong survival benefit for extensive LND after CRT in esophageal squamous cell carcinoma, especially in non-pCR patients. 相似文献2.
Michael A. Feuerstein Matthew Kent Wassim M. Bazzi Melanie Bernstein Paul Russo 《World journal of urology》2014,32(6):1531-1536
Purpose
To analyze the role of lymph node dissection (LND) in patients with large renal tumors.Methods
We performed a retrospective study of patients with renal cell carcinoma ≥7 cm in size undergoing surgery between 1990 and 2012. Primary outcome measures were recurrence-free and overall survival of patients who did and did not undergo LND. Cox proportional hazards regression models were created to account for known risk factors for recurrence and survival. Secondary outcomes were recurrence-free and overall survival by lymph node status, lymph node template and number of lymph nodes removed.Results
Of 524 patients, 164 had disease recurrence and 197 died. Median follow-up was 5 and 5.5 years for patients who did not die or have a recurrence, respectively. A total of 334 (64 %) patients underwent LND, and node-positive disease was identified in 26 (8 %). For patients who did and did not undergo LND, 5-year recurrence-free survival was 64 and 77 %, respectively. Five-year overall survival was 75 and 78 %, respectively. LND was not a predictor of recurrence or survival in multivariate analysis. Node-positive disease was associated with recurrence (p < 0.0005) and mortality (p = 0.032), although node-positive patients had a 5-year overall survival of 65 %.Conclusions
We did not find a difference in recurrence-free or overall survival in patients with ≥7-cm tumors whether or not they underwent LND. Node-positive disease was associated with worse outcomes, suggesting that LND provides important staging information that can be important in the design of adjuvant clinical trials. 相似文献3.
Purpose
This study aimed to investigate the effects of lymph node dissection (LND) on upper tract urothelial carcinoma (UTUC) without suspicious lymph node (LN) metastasis on preoperative imaging studies.Methods
From 1998 to 2012, 418 UTUC patients without suspicious LN metastasis on preoperative imaging studies were included. Patients were divided into two groups according to the performance of LND. The effects of LND on oncological outcomes were assessed after adjusting other variables. The mean follow-up duration was 69 months.Results
Among the 132 patients who underwent LND, LN metastasis was pathologically identified in 16 patients (12.1 %). The median number of resected LNs for patients who underwent LND was 7. On multivariate analysis, the number of resected LNs and pathologic T stage was significant predictors of LN metastasis. The 5-year recurrence-free survival was 76.4 % for patients without LND and 65.4 % for patients with LND (p = 0.126). In addition, there was no difference in 5-year overall survival between the 2 groups (without LND; 71.7 % vs. with LND; 72.1 %, p = 0.756). Multivariate analysis showed that pathologic T stage, tumor grade, and lymphovascular invasion were risk factors for recurrence. Age at surgery, tumor size, pathologic T stage, tumor grade, and lymphovascular invasion were significantly associated with overall survival. However, performance of LND was not associated with recurrence and survival.Conclusions
LND could be selectively performed in patients with clinically LN-negative UTUC based on patient/tumor characteristics and operative findings although sufficient LNs should be removed if LND is to be performed.4.
Skye C. Mayo Andrew D. Shore Hari Nathan Barish Edil Christopher L. Wolfgang Kenzo Hirose Joseph Herman Richard D. Schulick Michael A. Choti Timothy M. Pawlik 《Journal of gastrointestinal surgery》2010,14(10):1578-1591
Introduction
National Comprehensive Cancer Network (NCCN) guidelines recommend hepatic resection and lymphadenectomy (LND) for gallbladder adenocarcinoma (GBA). We sought to evaluate compliance with these recommendations and to assess trends in the management and survival of patients with GBA. 相似文献5.
Nicholas J. Farber Zorimar Rivera-Núñez Sinae Kim Brian Shinder Kushan Radadia Joshua Sterling Parth K. Modi Sharad Goyal Rahul Parikh Tina M. Mayer Robert E. Weiss Isaac Y. Kim Sammy E. Elsamra Thomas L. Jang Eric A. Singer 《Urologic oncology》2019,37(1):26-32
Purpose
Lymph node (LN) involvement in renal cell carcinoma (RCC) is associated with a poor prognosis. While lymph node dissection (LND) may provide diagnostic information, its therapeutic benefit remains controversial. Thus, the aim of our study is to analyze survival outcomes after LND for nonmetastatic RCC and to characterize contemporary practice patterns.Materials and methods
The National Cancer Database was queried for patients with nonmetastatic RCC who underwent either partial or radical nephrectomy from 2010 to 2014. A total of 11,867 underwent surgery and LND. Chi-square tests were used to examine differences in patient demographics. To minimize selection bias, propensity score matching (PSM) was used to select one control for each LND case (n?=?19,500). Cox regression analyses were conducted to examine overall survival (OS) in patients who received LND compared to those who did not.Results
Of all patients undergoing LND for RCC (n?=?11,867), 5%, 23%, 31%, 47% were performed for tumors of clinical T stage 1, 2, 3, and 4, respectively. Proportions of LND have not significantly changed from 2010 to 2014. No significant improvement in median OS for patients undergoing LND compared to no LND was shown (34.7 vs. 34.9 months, respectively; P?=?0.98). Similarly, no significant improvement in median OS was found for clinically LN positive patients undergoing LND compared to no LND (P?=?0.90). On Cox regression analysis, LND dissection was not associated with an OS benefit (hazard ratio: 1.00; 95% confidence interval 0.97 to 1.04).Conclusions
Among all RCC patients, LNDs are often performed for low stage disease, suggesting a potential overutilization of LND. No OS benefit was seen in any subgroup of patients undergoing LND. Further investigation is needed to determine which patient populations may benefit most from LND. 相似文献6.
Roscigno M Brausi M Heidenreich A Lotan Y Margulis V Shariat SF Van Poppel H Zigeuner R 《European urology》2011,60(4):776-783
Context
The role of lymph node dissection (LND) in patients treated with radical nephroureterectomy (RNU) for upper tract urothelial cancer (UTUC) is still controversial.Objective
To analyze the impact of lymph node invasion on the outcome of patients, the staging, and the possible therapeutic role of LND in UTUC.Evidence acquisition
A Medline search was conducted to identify original articles, review articles, and editorials addressing the role of LND in UTUC. Keywords included upper tract urothelial neoplasms, lymphadenectomy, lymph node excision, lymphatic metastases, nephroureterectomy, imaging, and survival.Evidence synthesis
Regional nodes are frequently involved in UTUC and represent the most common metastatic site. Regional nodal status is a significant predictor of patient outcomes, especially in invasive disease. Therefore, select patients treated with RNU at high risk for regional nodal metastases should undergo LND to improve disease staging, which would identify those who could benefit from adjuvant systemic therapy. Several retrospective studies suggested the potential therapeutic role of LND in UTUC. An accurate LND could remove some nodal micrometastases not identified on routine pathologic examination, thus improving local control and cancer-specific survival. Radical surgery and LND might be curative in a subpopulation with limited nodal disease, as described in bladder cancer. A clear knowledge of the limits of LND and a template of LND for UTUC are still needed.Conclusions
An extended LND can provide better disease staging and may be curative in patients with limited nodal disease. However, current evidence is based on retrospective studies, which limits the ability to standardize either the indication or the extent of LND. Prospective trials are required to determine the impact of LND on survival in patients with UTUC and identify patients for a risk-adapted approach such as close follow-up or adjuvant chemotherapy. 相似文献7.
Nicolas von Landenberg Jacqueline M. Speed Alexander P. Cole Thomas Seisen Stuart R. Lipsitz Philipp Gild Mani Menon Adam S. Kibel Florian Roghmann Joachim Noldus Maxine Sun Quoc-Dien Trinh 《Urologic oncology》2018,36(2):78.e13-78.e19
Purpose
An adequate pelvic lymph node dissection (LND) during radical cystectomy (RC) for muscle-invasive bladder cancer (BCa) has been shown to provide a survival benefit. We designed a study to assess the effect of adequate LND on overall survival (OS) according to cT stage and receipt of neoadjuvant chemotherapy (NAC).Material and methods
We identified 16,505 patients with localized BCa who received RC in the National Cancer Database (2004–2012). Inverse probability of treatment weighting (IPTW)-adjusted Kaplan-Meier and Cox regression analyses were used to compare OS between patients who received adequate LND (defined as ≥10 nodes removed) and those who did not, stratified by cT stage and receipt of NAC.Results
Overall 8,673 (52.55%) patients underwent adequate LND at RC for localized BCa. Median time to last follow-up was 55.49 months (IQR, 34.73–75.96 months). IPTW-adjusted Kaplan-Meier curves showed that median OS was improved in patients who received adequate LND (60.06 vs. 46.88 months). In patients who did not receive NAC, adequate LND was associated with an OS benefit for cT1/a/cis, cT2, and cT3/4 disease (P ≤ 0.008). Among patients who received NAC, adequate LND was not associated with any OS difference regardless of cT stage.Conclusion
Our data suggest that patients who did not receive NAC benefit from an adequate LND. However, the receipt of an adequate LND was not associated with an OS benefit in patients pretreated with NAC. Our study indicates that the receipt of NAC may eradicate micrometastatic disease, and thus limit the benefit of an adequate LND. 相似文献8.
Karim Bensalah Morgan Roupret Evanguelos Xylinas Shahrokh Shariat 《World journal of urology》2013,31(6):1369-1376
Introduction
Lymph node dissection (LND) has been advocated by oncologic surgeons to completely eradicate cancer. However, evidence for that strategy is solely based on poor quality data. Some randomized studies done outside the field of urology failed to show any benefit to LND. Our objective was to evaluate whether LND at the time of removal of prostate, kidney and urothelial carcinomas results in a survival benefit.Methods
For that purpose, we performed a systematic literature review.Results
For kidney cancer, LND might be able to cure some patients with N+ disease. In N0 patients, although a randomized trial has been completed, the value of LND remains uncertain. LND at the time of radical prostatectomy can be useful in some patients with lymph node invasion. However, studies on the impact of LND in pN0 patients are retrospective and conflictive. Extended LND has been recommended when performing a radical cystectomy based on improved outcomes observed in retrospective studies. However, these studies are limited by selection biases and results of ongoing randomized trials will specify the template and the advantages of LND when removing a bladder cancer. Recent data of large series of radical nephro-ureterectomies for upper tract urothelial carcinomas are conflicting. Some found a benefit of LND in N0 patients while others did not.Conclusion
The studies that support LND at the time of surgery for prostate, kidney and urothelial carcinomas have low level of evidence. This should encourage urologists to design and perform well-designed randomized trials to assess the potential survival impact of a commonly done procedure. 相似文献9.
Izak Faiena Amirali Salmasi Andrew T. Lenis Nicholas M. Donin David C. Johnson Kinan Bachour Alexandra Drakaki Arie S. Belldegrun Allan J. Pantuck Karim Chamie 《Urologic oncology》2018,36(2):79.e19-79.e26
Background
Patients with metastatic renal cell carcinoma (mRCC) have limited treatment options. Cytoreductive nephrectomy (CN) in select patients has been associated with improved survival. We aim to assess the survival in patients with mRCC and cN1 disease who underwent CN with and without lymph node dissection (LND).Methods
Data were abstracted from the National Cancer Database for patients diagnosed with mRCC and cN1 from 2003 to 2014. Using propensity matching, we compared overall survival (OS) in patients who underwent a LND. Kaplan-Meier survival analysis and multivariable Cox proportional hazards modeling were used. We performed a logistic regression to assess predictors of LND.Results
We identified 1,780 patients in the matched cohort, of which 71% underwent a LND. Patients undergoing LND were younger (P = 0.01) and had similar size tumors (5 cm; P = 0.31). Increased LN yield was associated with LND at an academic center (odds ratio = 1.91; 95% CI: 1.51–2.42; P<0.01). LND was associated with worse OS on KM analysis (log rank; P = 0.01). However, on multivariable analysis, we found no significant difference in OS (hazard ratio = 1.10; 95% CI: 0.94–1.29; P = 0.22). However, when adjusting for number of positive LN removed, an increase in LN yield was associated with improved OS (hazard ratio = 0.97; 95% CI: 0.95–0.99; P = 0.01).Conclusion
We demonstrate that patients with mRCC and cN1 disease undergoing LND did not have a survival benefit when compared with patients undergoing CN. However, lymph node yield showed an increase in survival when adjusting for the number of positive lymph nodes. Further research and validation of the ideal number of LN removed that may benefit patients is warranted. 相似文献10.
Thenappan Chandrasekar Hanan Goldberg Zachary Klaassen Rashid K. Sayyid Robert J. Hamilton Neil E. Fleshner Girish S. Kulkarni 《Urologic oncology》2018,36(1):13.e11-13.e18
Background
To examine usage trends, guideline adherence, and survival data for patients undergoing lymphadenectomy (LND) at the time of radical prostatectomy (RP) for Gleason 7 prostate cancer (PCa).Methods
The SEER database was queried for all patients with nonmetastatic biopsy Gleason 7 PCa from 2004 to 2013. Distribution and trends of LND were analyzed. The Memorial-Sloan Kettering Cancer Center nomogram was applied to stratify patients based on risk of nodal disease at time of RP (<5% risk or ≥5% risk). Analyses were performed to determine covariates associated with LND receipt at time of RP and cancer-specific mortality (CSM).Results
A total of 78,641 patients with either G34 or G43 PCa underwent RP (59,194 and 19,447, respectively). Of these patients, 61.2% of G34 and 73.5% of G43 patients underwent LND. During this 10-year period, the proportion of G43 patients undergoing LND remained relatively stable, whereas the proportion of G34 patients undergoing LND ranged between 55.9% and 67.9%. Regional differences were a predictor of LND receipt regardless of risk stratification, but did not translate to higher risk of CSM. Receipt of LND was not predictive of improved CSM in any of the cohorts analyzed.Conclusions
The role of LND for Gleason 7 prostate adenocarcinoma is not yet standardized, as indicated by the variability of LND dissection rates. Receipt of LND did not improve CSM, and in G43 patients, it predicted higher CSM. As the effect of LND on CSM is uncertain, further evaluation of oncologic benefit in this patient population is warranted. 相似文献11.
Purpose
To determine whether the number of lymph nodes (LNs) removed during radical cystectomy (RC) and pelvic LN dissection (LND) is associated with patient survival.Methods
Data on 450 patients who underwent RC and standard bilateral pelvic LND for urothelial bladder cancer without receiving neoadjuvant chemotherapy were reviewed. The extent of LND included common iliac artery bifurcation proximally, genitofemoral nerve laterally and the pelvic floor caudally. The impact of the number of LNs removed, analyzed as both continuous and categorical variables, on cancer-specific survival (CSS) and recurrence-free survival (RFS) was analyzed.Results
The median number of LNs removed was 18 (mean 19.6, range 10?C94). Of total 450 patients, 129 (28.7%) had node-positive (N?+) disease. For entire patients, the number of LNs removed was not associated with CSS and RFS in the analysis with continuous variable (P?=?0.715; P?=?0.442, respectively), quartiles (P?=?0.924; P?=?0.676, respectively), or <18 versus ??18 LNs removed (5-year CSS rates: 67.0% vs. 69.4%, P?=?0.679; 5-year RFS rates?=?59.4% vs. 60.6%, P?=?0.725, respectively). Similarly, the number of LNs removed was not associated with CSS and RFS in both N0 and N?+?patients, and in each T stage. Multivariate analyses showed that T stage and lymphovascular invasion were significant predictors for survival in N0 patients, whereas adjuvant chemotherapy and LN density were predictors for survival in N?+?patients.Conclusions
If meticulous LND was performed based on standardized LND template during RC, the number of LNs removed was not associated with patient survival. 相似文献12.
Mücke T Konen M Wagenpfeil S Kesting MR Wolff KD Hölzle F 《Annals of surgical oncology》2011,18(10):2739-2747
Background
Several multimodal strategies have been developed to treat patients with squamous cell carcinoma of the oral cavity (OSCC), and many have shown survival benefits. The theoretical advantages of preoperative chemoradiotherapy are downstaging of the primary tumor, an increased resectability rate, and the elimination of micrometastases. We aimed to assess whether a short low-dose preoperative radiotherapy regimen with concurrent low-dose chemotherapy with cisplatin improves outcomes for patients with OSCC undergoing surgical treatment with curative intent. 相似文献13.
Derya Tilki Thenappan Chandrasekar Umberto Capitanio Gaetano Ciancio Siamak Daneshmand Paolo Gontero Javier Gonzalez Axel Haferkamp Markus Hohenfellner William C. Huang Estefania Linares Espinós Adam Lorentz Juan I. Martinez-Salamanca Viraj A. Master James M. McKiernan Francesco Montorsi Giacomo Novara Sascha Pahernik Christopher P. Evans 《Urologic oncology》2018,36(2):79.e11-79.e17
Objectives
To study the effect of lymph node dissection (LND) at the time of nephrectomy and tumor thrombectomy on oncological outcomes in patients with renal cell carcinoma (RCC) and tumor thrombus.Patients and Methods
The records of 1,978 patients with RCC and tumor thrombus who underwent radical nephrectomy and tumor thrombectomy from 1985 to 2014 at 24 centers were analyzed. None of the patients had distant metastases. Extent and pathologic results of LND were compared with respect to cancer-specific survival (CSS). Multivariable Cox regression models were used to quantify the effect of multiple covariates.Results
LND was performed in 1,026 patients. In multivariable analysis, the presence of LN metastasis, the number of positive LNs, and LN density were independently associated with cancer-specific mortality (CSM). Clinical node-negative (cN?) disease was documented in 573 patients, 447 of them underwent LND with 43 cN? patients (9.6%) revealing positive LNs at pathology. LN positive cN? patients showed significantly better CSS when compared to LN positive cN+ patients. In multivariable analysis, positive cN status in LN positive patients was a significant predictor of CSM (HR, 2.923; P = 0.015).Conclusions
The number of positive nodes harvested during LND and LN density was strong prognostic indicators of CSS, while number of removed LNs did not have a significant effect on CSS. The rate of pN1 patients among clinically node-negative patients was relatively high, and LND in these patients suggested a survival benefit. However, only a randomized trial can determine the absolute benefit of LND in this setting. 相似文献14.
Andrew T. Lenis Nicholas M. Donin Izak Faiena Amirali Salmasi David C. Johnson Alexandra Drakaki Kiran Gollapudi Jeremy Blumberg Arie Belldegrun Allan Pantuck Karim Chamie 《Urologic oncology》2018,36(1):9.e1-9.e9
Objectives
With increasing utilization of robot-assisted surgery in urologic oncology, robotic nephroureterectomy (RNU) is becoming the surgical modality of choice for patients with upper tract urothelial carcinoma (UTUC). The role of surgical approach on lymph node dissection (LND) and lymph node (LN) yield is unclear, and potential therapeutic effects are unknown. Here we analyze the effects of surgical approach on LN yield, performance of LND, and overall survival (OS).Methods and materials
Patients with UTUC who underwent nephroureterectomy from 2010 to 2013 were identified in the National Cancer Database. Outcomes of interest included rate of LND, LN yield, and OS. Logistic regression analyses were used to predict performance of LND. Negative binomial regression was used to derive incidence rate ratios for LN yield. Cox proportional hazards models were used to quantify survival outcomes.Results
A total of 3,116 patients met inclusion criteria. LND was performed in 41% (314/762) of RNU, 27% (380/1385) of LNU cases, and 35% (340/969) of ONU (P<0.001). Compared with an ONU, patients who underwent a LNU had significantly lower odds of receiving a LND (OR = 0.70, 95% CI: 0.55–0.87) and had fewer LNs removed (IRR = 0.69, 95% CI: 0.60–0.80), while RNU trended toward increased LN yield (IRR = 1.14, 95% CI: 0.98–1.33). In a Cox proportional hazards model, increasing LN yield was associated with improved OS in patients with pN0 disease (HR = 0.97 per 1 unit increase in LN yield, 95% CI: 0.95–0.99).Conclusions
Compared with an ONU, RNU does not compromise performance of a LND and may be associated with improved LN yield. LNU is associated with the lowest rates of LND and LN yield. Increasing LN yield is associated with improved OS in patients with pN0 disease. Despite differential rates of LND and LN yield, surgical approach did not independently affect OS. 相似文献15.
Thomas Mücke Klaus-Dietrich Wolff Stefan Wagenpfeil David A. Mitchell Frank Hölzle 《Annals of surgical oncology》2010,17(1):287-295
Background
The purpose of this study was to examine whether or not immediate microvascular free flap reconstruction influences survival among treated patients suffering from oral squamous cell carcinoma (OSCC), controlling for demographic, clinical, and tumor characteristics. 相似文献16.
Tseng-Cheng Chen MD Pei-Jen Lou MD PhD Jenq-Yuh Ko MD PhD Tsung-Lin Yang MD PhD Wu-Chia Lo MD Ya-Ling Hu RN MSc Cheng-Ping Wang MD 《Annals of surgical oncology》2011,18(2):497-504
Background
The impact of submandibular gland (SMG) preservation during neck dissection on the survival of patients with early-stage oral squamous-cell carcinoma (OSCC) remains undocumented.Methods
The medical records of all patients with early-stage OSCC (stage I and II) who underwent wide excision of the primary tumor and simultaneous neck dissection between 1999 and 2006 at our facility were retrospectively reviewed.Results
We analyzed 408 patients, including 33 patients with and 375 patients without SMG preservation. The 5-year disease-free and overall survival rates were 78.8% and 90.9% for the patients with SMG preservation and 75.4% and 90.4% for the patients without SMG preservation, and these differences were not statistically significant (P = 0.79, P = 0.99, respectively). Similar survival rates between patients with and without SMG preservation were observed in those with oral tongue squamous-cell carcinoma (SCC) and with buccal SCC. Patients with T2 OSCC with SMG preservation had significantly lower 5-year disease-free survival rate than those without SMG preservation (P = 0.02), but overall survival rates were similar between these two groups.Conclusions
Preservation of the SMG during neck dissection may be oncologically safe in patients with T1 OSCC, but the feasibility of SMG preservation seems less clear for T2 OSCC. 相似文献17.
Soichiro Ishihara MD PhD Tamuro Hayama MD PhD Hideki Yamada MD PhD Keijiro Nozawa MD PhD Keiji Matsuda MD PhD Hiroaki Miyata PhD Satomi Yoneyama MD PhD Toshiaki Tanaka MD PhD Junichiro Tanaka MD PhD Tomomichi Kiyomatsu MD PhD Kazushige Kawai MD PhD Hioaki Nozawa MD PhD Takamitsu Kanazawa MD PhD Shinsuke Kazama MD PhD Hironori Yamaguchi MD PhD Eiji Sunami MD PhD Joji Kitayama MD PhD Yojiro Hashiguchi MD PhD Kenichi Sugihara MD PhD Toshiaki Watanabe MD PhD 《Annals of surgical oncology》2014,21(9):2949-2955
Background
Retrospective studies have shown that primary tumor resection improves the prognosis of patients with colorectal cancer with unresectable metastasis (mCRC). Prognostic significance of lymph node dissection (LND) in mCRC has not been examined previously. The aim of this study was to investigate the prognostic impact of primary tumor resection and LND in mCRC.Methods
A total of 1,982 patients with mCRC from January 1997 to December 2007 were retrospectively studied. The impact of primary tumor resection and LND on overall survival (OS) was analyzed using Cox proportional hazards model and propensity score analysis to mitigate the selection bias. Covariates in the models for propensity scores included treatment period, institution, age, sex, carcinoembryonic antigen, tumor location, histology, depth, lymph node metastasis, lymphovascular invasion, and number of metastatic organs.Results
In a multivariate analysis, primary tumor resection and treatment in the latter period were associated with an improved OS, and age over 70 years, female sex, lymph node metastasis, and multiple organ metastasis were associated with a decreased OS. In the propensity-matched cohort, patients treated with primary tumor resection showed a significantly better OS than those without tumor resection (median OS 13.8 vs. 6.3 months; p = 0.0001). Furthermore, among patients treated with primary tumor resection, patients treated with D3 LND showed a significantly better OS than those with less extensive LND (median OS 17.2 vs. 13.7 months; p < 0.0001).Conclusions
It was suggested that primary tumor resection with D3 LND improves the survival of patients with mCRC. 相似文献18.
Thomas?Seisen Shahrokh?F.?Shariat Olivier?Cussenot Benoit?Peyronnet Rapha?le?Renard-Penna Pierre?Colin Morgan?Rouprêt
Purpose
To review the contemporary data on the role of lymph node dissection (LND) at the time of radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).Methods
A computerized bibliographic search using the following protocol (“Nephroureterectomy”) AND (“Lymphadenectomy” OR “Lymph node” OR “Lymphatic”) was performed in MEDLINE to identify all original and review articles that addressed the role of LND for UTUC.Results
Regional lymph node (LN) boundaries of UTUC have been recently investigated in mapping studies to propose anatomic templates of LND according to the laterality and location of primary tumor. Although these anatomic templates remained poorly described, most reports supported the staging benefit of LND that allowed for risk stratification of patients with (pN+) or without (pN0) LN metastases from those who did not undergo such a procedure (pNx). In addition, the therapeutic benefit of LND at the time of RNU was supported by better oncological outcomes obtained after complete LND when compared to incomplete or no LND, especially in the group of patients with advanced disease. The number of LNs removed was also correlated with both, more accurate staging and greater cancer-specific survival after LND, whose feasibility and safety have been validated in prospective studies.Conclusions
Despite mostly based on data with level of evidence 3, our comprehensive review of the literature supports the staging and therapeutic benefits of LND at the time of RNU for UTUC, which are particularly significant for patients with muscle-invasive or locally advanced disease.19.
Harman M. Bruins Erik Veskimae Virginia Hernandez Mari Imamura Molly M. Neuberger Philip Dahm Fiona Stewart Thomas B. Lam James N’Dow Antoine G. van der Heijden Eva Compérat Nigel C. Cowan Maria De Santis Georgios Gakis Thierry Lebret Maria J. Ribal Amir Sherif J. Alfred Witjes 《European urology》2014
Context
Controversy exists regarding the therapeutic value of lymphadenectomy (LND) in patients undergoing radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC).Objective
To systematically review the relevant literature assessing the impact of LND on oncologic and perioperative outcomes in patients undergoing RC for MIBC.Evidence acquisition
Medline, Medline In-Process, Embase, the Cochrane Central Register of Controlled Trials, and the Latin American and Caribbean Center on Health Sciences Information (LILACS) were searched up to December 2013. Comparative studies reporting on no LND, limited LND (L-LND), standard LND (S-LND), extended LND (E-LND), superextended LND (SE-LND), and oncologic and perioperative outcomes were included. Risk-of-bias and confounding assessments were performed.Evidence synthesis
Twenty-three studies reporting on 19 793 patients were included. All but one study were retrospective. Planned meta-analyses were not possible because of study heterogeneity; therefore, data were synthesized narratively. There were high risks of bias and confounding across most studies as well as extreme heterogeneity in the definition of the anatomic boundaries of LND templates. All seven studies comparing LND with no LND favored LND in terms of better oncologic outcomes. Seven of 14 studies comparing (super)extended LND with L-LND or S-LND reported a beneficial outcome for (super)extended LND in at least a subset of patients. No difference in outcome was reported in two studies comparing E-LND and S-LND. The comparative harms of different extents of LND remain unclear.Conclusions
Although the quality of the data was poor, the available evidence indicates that any kind of LND is advantageous over no LND. Similarly, E-LND appears to be superior to lesser degrees of dissection, while SE-LND offered no additional benefits. It is hoped that data from ongoing randomized clinical trials will clarify remaining uncertainties.Patient summary
The current literature suggests that removal of lymph nodes in bladder cancer surgery is beneficial and might result in better outcomes in terms of prolonging survival; however, the quality of the available studies is poor, and high-quality studies are needed. 相似文献20.
Chang Hyun Kim MD Jung Wook Huh MD PhD Hyeong Rok Kim MD PhD Young Jin Kim MD PhD 《Annals of surgical oncology》2014,21(4):1361-1368