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中华腔镜泌尿外科杂志(电子版)

中华腔镜泌尿外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (05) : 495 -499. doi: 10.3877/cma.j.issn.1674-3253.2023.05.014

临床研究

盆腔淋巴结大小对膀胱癌复发的影响
罗辉, 熊珍珍, 黄令杰, 林山, 李金雨†()   
  1. 363000　福建漳州，中国人民解放军联勤保障部队第909医院（厦门大学附属东南医院）泌尿外科
  • 收稿日期:2022-03-11 出版日期:2023-10-01
  • 通信作者: 李金雨
  • 基金资助:
    联勤保障部队第909医院青年苗圃基金(18Y007)

Effect of pelvic lymph node size on recurrence of bladder cancer

Hui Luo, Zhenzhen Xiong, Lingjie Huang, Shan Lin, Jinyu Li†()   

  1. Department of Urology, the 909th Hospital of the Chinese People's Liberation Army Joint Logistic Support Force (Dongnan Hospital of Xiamen University), Zhangzhou 363000, China
  • Received:2022-03-11 Published:2023-10-01
  • Corresponding author: Jinyu Li
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罗辉, 熊珍珍, 黄令杰, 林山, 李金雨. 盆腔淋巴结大小对膀胱癌复发的影响[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(05): 495-499.

Hui Luo, Zhenzhen Xiong, Lingjie Huang, Shan Lin, Jinyu Li. Effect of pelvic lymph node size on recurrence of bladder cancer[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(05): 495-499.

目的

探讨盆腔淋巴结平均直径对无淋巴结转移肌层浸润性膀胱癌患者肿瘤复发的影响。

方法

回顾性分析联勤保障部队第九〇九医院2012至2016年收治71例膀胱癌患者临床病理资料，根据随访结果，27例发生肿瘤复发，采用ROC受试工作者曲线分析盆腔淋巴结平均直径预测肿瘤复发最佳界值，分析入组患者盆腔淋巴结平均直径与临床病理学关系，单因素和Cox多因素分析肿瘤复发影响因素。

结果

淋巴结平均直径预测肿瘤复发的ROC曲线下面积（AUC）为0.749，最佳界值为0.675 cm，95%CI为0.632~0.865，灵敏度为0.852，特异度为0.648；肿瘤分期T3、肿瘤低分化、脉管侵犯阳性、肿瘤复发的患者淋巴结平均直径增大（t=-2.021、-2.131、-2.569、-3.945，P<0.05）；单因素分析发现肿瘤分期T3、肿瘤低分化、脉管侵犯阳性、淋巴结平均直径>0.675 cm的患者肿瘤复发率较高（χ2=23.608、3.968、12.776、8.925，P<0.05）；多因素分析发现肿瘤分期T3和淋巴结平均直径>0.675 cm是肿瘤复发的独立危险因素（95%CI=1.627~9.562、0.163~2.050，P<0.05）。

结论

无淋巴结转移肌层浸润性膀胱癌患者中盆腔淋巴结直径与肿瘤分期、分化和脉管侵犯相关，并且是肿瘤复发的独立危险因素，在判断预后和制定个体化治疗方案方面可能具有一定的临床意义。

关键词: 淋巴结, 直径, 膀胱肿瘤, 复发, 预后
Objective

To investigate the effect of mean pelvic lymph node diameter on tumor recurrence in patients with muscle-invasive bladder cancer without lymph node metastasis.

Methods

The clinicopathological data of 71 patients with bladder cancer treated in 909th Hospital of the Chinese People's Liberation Army Joint Logistic Support Force from 2012 to 2016 were retrospectively analyzed.According to the follow-up results, tumor recurrence occurred in 27 cases. The ROC author curve was used to analyze the optimal threshold for predicting tumor recurrence.The relationship between the mean diameter of pelvic lymph nodes and clinicopathology were analyzed.Univariate and Cox multivariate analysis of tumor recurrence factors.

Results

The area under ROC curve (AUC) was 0.749, the optimal limit of average lymph node diameter was 0.675 cm, 95%CI was 0.632-0.865, sensitivity was 0.852, and specificity was 0.648. The mean diameter of lymph nodes increased in patients with tumor stage T3, poorly differentiated tumor, positive vascular invasion and tumor recurrence (t=-2.021, -2.131, -2.569, -3.945, P<0.05). Univariate analysis showed that patients with tumor stage T3, low tumor differentiation, positive vascular invasion and mean lymph node diameter >0.675 cm had a higher recurrence rate (χ2=23.608, 3.968, 12.776, 8.925, P<0.05). Multivariate analysis showed that T3 and mean lymph node diameter >0.675 cm were independent risk factors for tumor recurrence (95%CI= 1.627-9.562, 0.163-2.050, P<0.05).

Conclusions

Pelvic lymph node diameter is associated with tumor stage, differentiation and vascular invasion in patients with muscle-invasive bladder cancer without lymph node metastasis, which is an independent risk factor for tumor recurrence and may have certain clinical significance in determining prognosis and formulating individualized treatment plan.

Key words: Lymph nodes, Diameter, Bladder cancer, Recurrence, Prognosis
图1 淋巴结平均直径预测肿瘤复发的ROC曲线
表1 淋巴结平均直径与临床病理资料关系(±s)
分组 例数 淋巴结平均直径(cm) t值 P值
年龄(岁)     0.147 0.884
≤60 20 0.73±0.14    
> 60 51 0.72±0.14    
性别     0.475 0.636
女 15 0.74±0.13    
男 56 0.72±0.14    
吸烟史     -0.254 0.800
无 29 0.72±0.14    
有 42 0.73±0.14    
肿瘤分期     -2.021 0.047
T2 46 0.70±0.13    
T3 25 0.77±0.15    
肿瘤分化     -2.131 0.037
中高分化 37 0.69±0.13    
低分化 34 0.76±0.14    
肿瘤大小(cm)     0.293 0.770
≤2 36 0.73±0.15    
> 2 35 0.72±0.14    
三角区肿瘤     0.423 0.673
否 43 0.73±0.15    
是 28 0.72±0.13    
脉管侵犯     -2.569 0.012
否 35 0.68±0.15    
是 36 0.77±0.12    
淋巴结个数     -1.165 0.248
≤13 37 0.71±0.14    
> 13 34 0.75±0.14    
肿瘤复发     -3.945 <0.001
否 44 0.67±0.10    
是 27 0.81±0.16    
表2 两组膀胱肿瘤患者术前资料对比(±s)
变量 复发组（n=27） 未复发组（n=44） t值 P值
白细胞(×109/L) 7.3±2.1 7.4±2.0 -0.764 0.454
C-反应蛋白(mg/L) 5.9±1.2 5.7±1.3 0.559 0.637
降钙素原(ng/ml) 0.26±0.07 0.31±0.09 -0.661 0.492
手术间隔时间(d) 4.3±1.1 4.2±1.1 1.438 0.077
表3 膀胱肿瘤复发单因素分析(例)
因素 复发组（n=27） 未复发组（n=44） χ2值 P值
年龄（岁）     2.005 0.157
≤60 5 15    
> 60 22 29    
性别     0.031 0.859
女 6 9    
男 21 35    
吸烟史     0.962 0.327
无 13 16    
有 14 28    
肿瘤分期     23.608 <0.001
T2 8 38    
T3 19 6    
肿瘤分化     3.968 0.046
中高分化 10 27    
低分化 17 17    
肿瘤大小(cm)     0.410 0.522
≤2 15 21    
> 2 12 23    
三角区肿瘤     0.962 0.327
否 14 28    
是 13 26    
脉管侵犯     12.776 <0.001
否 6 29    
是 21 15    
淋巴结个数     0.274 0.600
≤13 13 24    
> 13 14 20    
淋巴结平均直径(cm)     8.925* 0.005
≤0.675 4 22    
>0.675 23 22    
表4 膀胱肿瘤复发Cox多因素分析
因素 β SE Wald χ2 HR 95%CI P值
肿瘤分期T3 1.327 0.452 9.227 3.944 1.627~9.562 0.002
肿瘤低分化 0.509 0.432 1.934 1.664 0.714~3.877 0.238
脉管浸润阳性 0.610 0.547 1.241 1.840 0.629~5.376 0.265
淋巴结平均直径>0.675 cm 0.549 0.646 0.722 1.577 0.163~2.050 0.036
[15]
Yp S, Mcwilliam A, Pj H, et al. Organ preservation in bladder cancer: An opportunity for truly personalized treatment[J]. Nat Rev Urol, 2019, 16(9): 511-522.
[16]
Nian ZX, Ning K, Li MS, et al. Laparoscopic radical cystectomy with novel orthotopic neobladder with bilateral isoperistaltic afferent limbs: initial experience[J]. Int Braz J Urol, 2017, 43(1): 57-66.
[17]
Ghodoussipour S, Daneshmand S. Current controversies on the role of lymphadenectomy for bladder cancer[J]. Urol Oncol, 2019, 37(3): 193-200.
[18]
Abdi H, Pourmalek F, Gleave ME, et al. Balancing risk and benefit of extended pelvic lymph node dissection in patients undergoing radical cystectomy[J]. World J Urol, 2016, 34(1): 41-48
[19]
Moaee MK, HoyeeS, Jensen JB.Extended versus superextended lymph-node dissection in radical cystectomy: subgroup analysis of possible recurrence-free survival aeeecu benefit[J]. Scand J Urol, 2016, 50 (3): 175-180.
[20]
Wang Y, Kang XL, Zeng FC, et al. Correlations of Foxo3 and Foxo4 and Foxo4 expressions with clinicopathological features and prognosis of bladder cancer[J]. Pathol Res Pract, 2017, 213(7): 766-772.
[21]
Zhen SU, Jian LI, Teng XH, et al. The expression of CD34 and Podoplanin in bladder cancer and the correlation with lymph node metastasis and muscular invasion[J]. Oncol Prog, 2016, 14(5): 474-476.
[22]
Lu Y, Jiang J, Ren C, The clinicopathological and prognostic value of the pretreatment neutrophil-to-lymphocyteration in small cell lung cancer:a mare-analusis[J]. Plos One, 2020, 15(4): e230979.
[23]
Velazquez CA, Alcal SA, Espi J, et al. Unveiling the link between inliammation and adaptive immunity in breast cancer[J]. Front Immunol, 2019, 7(29): 56-67.
[24]
Tang J, Yang Z, Wang Z, et al. Foxp3 is correlated with VEGF-C expression and lymphangiogenesis in cervical cancer[J]. World J Surg Oncol, 2017, 15(1): 173-181.
[25]
Witjes JA, Bruins HM, Cathomas R, et al. European association of urology guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2020 guidelines[J]. Eur Urol, 2021, 79(1): 82-104.
[1]
贺宇彤, 李道娟, 梁迪, 等. 2014年中国膀胱癌发病和死亡分析[J]. 中华肿瘤杂志, 2018, 40(9): 647-652.
[2]
Jubber I, Ong S, Bukavina L, et al. Epidemiology of Bladder Cancer in 2023: A Systematic Review of Risk Factors[J]. Eur Urol, 2023, 84(2): 176-190.
[3]
Kamat AM, Hahn NM, Efstathiou JA, et al. Bladder cancer[J].Lancet, 2016, 388(10061): 2796-2810.
[4]
Mochini M, Arbelaez E, Cornelius J, et al. Pattern of node metastases in patients treated with radical cystectomy and extended or superextended pelvic lymph node dissection due to bladder cancer[J].Urol Oncol, 2018, 36(6): e9-e14.
[5]
Wang SD, Ge CG, Zhang JY. Incidence, prognostic factors and survival in bladder cancer patients: a population-based study[J].Transl Cancer Res, 2022, 11(8): 2742-2756
[6]
Choi SY, You D, Hong B, et al. Impact of lymph node dissection in radical cystectomy for bladder cancer:How many vs how far? [J].Surg Oncol, 2019, 30: 109-116.
[7]
Yuk HD, JeongCW, Kwak C, et al.Lymphovascular invasion have a similar prognostic value as lymph node involvement in patients undergoing radical cystectomy with urothelial carcinoma[J].Sci Rep, 2018, 8(1): 15928.
[8]
Hwang EC, Sathianathen NJ, Imamura M, et al. Extend versus standard lymph node dissection for urothelial carcinoma for the bladder in patients undergoing radical cystectomy[J]. Cochrane Datebase Syst Rev, 2019, 5(5): CD013336.
[9]
Zhou CF, Ma J, Huang L, et al. Cervical squamous cell carcinoma secreted exosomal miR-221-3p promotes lymphangiogenesis and lymphatic metastasis by targeting VASH1[J]. Oncogene, 2019, 38(8): 1256-1268.
[10]
Graves S, Seagle BLL, Strohl AE, et a1. Survival after pelvic exenteration for cervical cancer：a national cancer database study[J]．Int J Gyneeol Cancer, 2017, 27(2): 390-395．
[11]
杨守东,孙江连,卢浩彬,等. 非肌层浸润性膀胱癌基底注水后经尿道逆行膀胱肿瘤整块剜除术疗效分析[J]. 新医学, 2022, 53(8): 582-587.
[12]
Crocerossa F, Autorino R, Carbonara U, et a1. Extent of lymph node dissection and impact on survival in radical cystectomy for advanced bladder cancer[J]. Curr Opin Urol, 2022, 32(6): 607-613.
[13]
Lenis AT, Lec PM, Michel J, et al. Predictors of adequate lymph node dissection in patients with non-muscle invasive bladder cancer undergoing radical cystectomy and effect on survival[J].Urol Oncol, 2020, 38(10): 796.
[14]
Tang YL, Huy Y, Wang J, et al. A novel risk score based on a combined singature of 10 immune system genes to predict bladder cancer prognosis [J]. Int Immunopharmacol, 2020, 87: 106851.
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