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Is there a therapeutic role for post-chemotherapy retroperitoneal lymph node dissection in metastatic transitional cell carcinoma of the bladder?
引用本文:Sweeney P,Millikan R,Donat M,Wood CG,Radtke AS,Pettaway CA,Grossman HB,Dinney CP,Swanson DA,Pisters LL. Is there a therapeutic role for post-chemotherapy retroperitoneal lymph node dissection in metastatic transitional cell carcinoma of the bladder?[J]. The Journal of urology, 2003, 169(6): 2113-2117. DOI: 10.1097/01.ju.0000067601.29966.4a
作者姓名:Sweeney P  Millikan R  Donat M  Wood CG  Radtke AS  Pettaway CA  Grossman HB  Dinney CP  Swanson DA  Pisters LL
摘    要:


Is There a Therapeutic Role for Post-Chemotherapy Retroperitoneal Lymph Node Dissection in Metastatic Transitional Cell Carcinoma of the Bladder?
Sweeney Paul,Millikan Randall,Donat Machelle,Wood Christopher G,Radtke Arlene Siefker,Pettaway Curtis A,Grossman H Barton,Dinney Colin P N,Swanson David A,Pisters Louis L. Is There a Therapeutic Role for Post-Chemotherapy Retroperitoneal Lymph Node Dissection in Metastatic Transitional Cell Carcinoma of the Bladder?[J]. The Journal of urology, 2003, 169(6): 2113-2117. DOI: 10.1097/01.ju.0000067601.29966.4a
Authors:Sweeney Paul  Millikan Randall  Donat Machelle  Wood Christopher G  Radtke Arlene Siefker  Pettaway Curtis A  Grossman H Barton  Dinney Colin P N  Swanson David A  Pisters Louis L
Affiliation:

aFrom the Departments of Urology and Genitourinary Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas, and Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York

Abstract:PURPOSE: We identified a subset of patients with bladder cancer (transitional cell carcinoma) and regional nodal metastasis to the retroperitoneal lymph nodes without detectable systemic dissemination. While the majority of these patients respond initially to chemotherapy, most have disease relapse at the same site within a year. We report the results of a phase II study exploring the potential benefit of retroperitoneal lymph node dissection in patients with transitional cell carcinoma of the bladder in whom disease has shown a significant response to chemotherapy. MATERIALS AND METHODS: A total of 11 patients with biopsy proven metastatic transitional cell carcinoma in the retroperitoneal lymph nodes and no evidence of visceral metastatic disease in whom disease showed a significant response to chemotherapy underwent complete bilateral retroperitoneal lymph node dissection. The end point of study was disease specific survival, calculated from the time of retroperitoneal lymph node dissection to death from transitional cell carcinoma of the bladder. RESULTS: Four patients underwent delayed retroperitoneal lymph node dissection. Seven patients underwent concurrent cystectomy, and pelvic and retroperitoneal lymph node dissection. There was no perioperative mortality. Nine patients had evidence of residual disease in the retroperitoneal nodes. Seven patients have recurrence outside of the original surgical field with a median time to recurrence of 7 months and 6 died at a median time to death of 8 months (range 5 to 14). One patient with retrocrural recurrence attained a complete response to salvage chemotherapy and remained disease-free 57 months after retroperitoneal lymph node dissection. For all 11 patients median disease specific and recurrence-free survival rates were 14 and 7 months, respectively. Four-year disease specific and recurrence-free survival rates were 36% and 27%, respectively. We stratified the patients based on the number of involved lymph nodes at retroperitoneal lymph node dissection and noted that viable tumor in no more than 2 lymph nodes correlated with greater disease specific and recurrence-free survival (p = 0.006 and 0.01, respectively). CONCLUSIONS: Retroperitoneal lymph node dissection can be safely performed for metastatic transitional cell carcinoma. Retroperitoneal lymph node dissection has curative potential, particularly in patients with viable tumor in no more than 2 lymph nodes after chemotherapy.
Keywords:bladder   carcinoma, transitional cell   lymph node dissection   neoplasm metastasis   drug therapy
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