Pattern and risk factors of lymph node metastasis in patients undergoing laparoscopic radical cystectomy and lymph node dissection for bladder cancer

doi:10.3877/cma.j.issn.1674-3253.2018.06.009

Abstract

Abstract:

Objective

To investigate the pattern and risk factors of pelvic lymph node metastasis in patients with bladder cancer treated with laparoscopic radical cystectomy and pelvic lymphadenectomy.

Methods

Data of 285 patients underwent laparoscopic radical cystectomy and pelvic lymphadenectomy in our hospital from 2008 to 2016 by the same surgeon was retrospectively collected. The characteristics and risk factors of lymph node metastasis were analyzed.

Results

285 patients (24.2%) had lymph node metastasis. The most common site of lymph node metastasis was the internal iliac/obturator lymph node (57/69, 82.6%), followed by the external iliac lymph node (37/69, 53.6%). External pelvic lymph node metastasis was accompanied by true pelvic lymph node metastasis. Tumor location and lymph node metastasis were significantly correlated. However, lymphatic drainage from the bladder seemed to be bilateral. The incidence in different stages: 4.6% (4/87) in T1, 18.0% (18/100) in T2, 50.8% (30/59) in T3, 68.0% (17/25) in T4. The incidence of lymph node metastasis was positively correlated with tumor stage.

Conclusion

The most common lymph node metastases in bladder cancer are the internal iliac/obturator and external iliac lymph nodes. Radical cystectomy should be performed with lymphadenectomy including at least bilateral internal iliac, obturator and external iliac lymph nodes.

Key words: Urinary bladder neoplasms, Laparoscopy, Cystectomy, Lymphadenectomy

Weibin Xie, Hao Liu, Jianqiu Kong, Yangfan Su, Junming Bi, Wen Dong, Tianxin Lin, Jian Huang. Pattern and risk factors of lymph node metastasis in patients undergoing laparoscopic radical cystectomy and lymph node dissection for bladder cancer[J]. Chinese Journal of Endourology(Electronic Edition), 2018, 12(06): 397-401.

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References 23

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项目		例（%）
性别		?
?	男	242（84.9）
?	女	043（15.1）
分期		?
?	pTa	07（2.5）
?	pTis	07（2.5）
?	pT1	087（30.5）
?	pT2	100（35.1）
?	pT3	059（20.7）
?	pT4	25（8.8）
分级		?
?	低级别/G1+G2	043（15.1）
?	高级别/G3	242（84.9）
淋巴结分期		?
?	pN0	216（75.8）
?	pN1	27（9.5）
?	pN2	033（11.6）
?	pN3	09（3.2）

项目		例（%）
性别		?
?	男	242（84.9）
?	女	043（15.1）
分期		?
?	pTa	07（2.5）
?	pTis	07（2.5）
?	pT1	087（30.5）
?	pT2	100（35.1）
?	pT3	059（20.7）
?	pT4	25（8.8）
分级		?
?	低级别/G1+G2	043（15.1）
?	高级别/G3	242（84.9）
淋巴结分期		?
?	pN0	216（75.8）
?	pN1	27（9.5）
?	pN2	033（11.6）
?	pN3	09（3.2）

变量		单因素分析		多因素分析
变量		OR（95%CI）	P值	OR（95%CI）	P值
年龄（>65 vs ≤65岁）		1.24（0.72-2.13）	0.446	?	?
性别（女vs男） BMI（≥24 vs <24 kg/m²）		0.46（0.19-1.14）	0.095	?	?
性别（女vs男） BMI（≥24 vs <24 kg/m²）		0.73（0.41-1.31）	0.288	?	?
吸烟史（是vs否）		1.48（0.41-1.31）	0.166	?	?
三角区肿瘤（是vs否）		0.86（0.47-1.58）	0.622	?	?
分期		?	?	?	?
?	<T2	Ref	?	?	?
?	T2	7.49（0.47-1.58）	<0.010	4.65（1.50-14.43）	<0.010
?	>T2	041.07（12.04-140.1）	<0.001	25.55（9.79-117.77）	<0.001
分级		?	?	?	?
?	低级别（G1+G2）	Ref	?	?	?
?	高级别（G3）	7.85（1.85-33.36）	<0.01	2.87（0.61-13.43）	0.182

变量		单因素分析		多因素分析
变量		OR（95%CI）	P值	OR（95%CI）	P值
年龄（>65 vs ≤65岁）		1.24（0.72-2.13）	0.446	?	?
性别（女vs男） BMI（≥24 vs <24 kg/m²）		0.46（0.19-1.14）	0.095	?	?
性别（女vs男） BMI（≥24 vs <24 kg/m²）		0.73（0.41-1.31）	0.288	?	?
吸烟史（是vs否）		1.48（0.41-1.31）	0.166	?	?
三角区肿瘤（是vs否）		0.86（0.47-1.58）	0.622	?	?
分期		?	?	?	?
?	<T2	Ref	?	?	?
?	T2	7.49（0.47-1.58）	<0.010	4.65（1.50-14.43）	<0.010
?	>T2	041.07（12.04-140.1）	<0.001	25.55（9.79-117.77）	<0.001
分级		?	?	?	?
?	低级别（G1+G2）	Ref	?	?	?
?	高级别（G3）	7.85（1.85-33.36）	<0.01	2.87（0.61-13.43）	0.182

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