淋巴廓清術對於腎盂泌尿上皮癌的影響
方仁愷、張議徽、張兆祥、楊啟瑞、陳汶吉、葉進仲、連啟舜、陳冠亨、蕭博任、吳錫金、謝博帆、黃志平、李宗睿、張英傑
中國醫藥大學附設醫院 泌尿部
Outcome of lymph node dissection in renal pelvis urothelial carcinoma
Jen Kai Fang, Yi-Huei Chang, Chao-Hsiang Chang, Chi-Rei Yang, Wen-Chi Chen, Chin-Chung Yeh, Chi-Shun Lien, Guang-Heng Chen, Po-Jen Hsiao, Hsi-Chin Wu, Po-Fan Hsieh, Chi-Ping Huang, Tzung-Ruei Li, Ying-Chieh Chang
Department of Urology, China Medical University Hospital, Taichung, Taiwan
Purpose
Lymph node dissection at the time of radical nephroureterectomy with bladder cuff excision(NUBCE) for upper urinary tract urothelial carcinoma (UTUC) is controversial. Some previous studies revealed that lymph node dissection had staging and survival benefit for muscle invasive renal pelvis UTUC. However, most of the studies were retrospective. Besides, there is no precise parameter for preoperative staging. We analyzed lymph node dissection of UTUC in China Medical University Hospital.
Materials and Methods
We retrospectively reviewed patients with UTUC who received NUBCE between May 2013 and May 2018. Patients with pathological stage T2-T4 renal pelvis UC without lymphadenopathy in preoperative image were included in analysis.
Results
97 patients were included. Lymph node dissection were performed in 64 patients but not in 33 patients. The median lymph node dissection number was 6 (IQR 2-14). 13 patients had lymph node metastasis. Most of the lymph node metastasis location was hilar (8 patients) and para-aorta /para-cava (7 patients). Comparing the overall survival, cancer specific survival, progression free survival. There was no significant difference between the two groups. Furthermore, among lymphovascular invasion patients, lymph node dissection group still had similar survival with control group.
Conclusions
Lymph node dissection at the time of NUBCE had the benefit of staging. Adjuvant treatment could be performed in lymph node metastasis patients. However, the therapeutic role of lymph node dissection is still unclear.