北京大学学报(医学版) ›› 2014, Vol. 46 ›› Issue (4): 524-527.

• 论著 • 上一篇    下一篇

膀胱尿路上皮癌淋巴结转移特点:单中心522例膀胱根治性切除病例回顾

郝瀚*,吴鑫*,郑卫,虞巍,范宇,何群,李学松,周利群△   

  1. (北京大学第一医院泌尿外科,北京大学泌尿外科研究所,国家泌尿、男性生殖系肿瘤研究中心,北京100034)
  • 出版日期:2014-08-18 发布日期:2014-08-18

Characteristics of lymph node metastasis in patients undergoing radical cystectomy for bladder cancer:a retrospective single-center study of 522 cases

HAO Han*, WU Xin*, ZHENG Wei, YU Wei, FAN Yu, HE Qun, LI Xue-song, ZHOU Li-qun△   

  1. (Department of Urology, Peking University First Hospital, Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China)
  • Online:2014-08-18 Published:2014-08-18

摘要: 目的:分析膀胱癌淋巴结转移的特点以及影响膀胱癌淋巴结转移的相关影响因素。方法:回顾研究1998年至2012年北京大学第一医院泌尿外科行膀胱根治性切除同时行盆腔淋巴结清扫的患者,共522例,分析其淋巴结的转移情况,以及影响淋巴结转移的相关因素。结果:522例术前诊断为膀胱尿路上皮癌的患者(包括5例原位癌),99例存在淋巴结转移,淋巴结转移率19.0%, T1期淋巴结转移发生率3.7%(6/164),T2期10.5%(17/160),T3期36.7%(40/107),T4期41.9%(36/86)。最常见的淋巴结转移部位为髂内/闭孔淋巴结(77/99,77.8%),其次是髂外淋巴结(35/99,35.4%)。清扫的淋巴结总数平均11.6个(1~51个),阳性淋巴结占淋巴结总数的比例平均为44.1%。 淋巴结转移与肿瘤分期(P<0.01,OR 2.71,95% CI 2.13~3.44)和肿瘤分级(P<0.01,OR 3.81,95% CI 1.66~8.74)呈正相关,与年龄、性别、吸烟史、体重等因素均无相关性。结论:淋巴结转移是膀胱癌最常见的转移途径之一,发生淋巴结转移与肿瘤分级和分期呈正相关,最常见的转移部位是髂内/闭孔淋巴结,其次是髂外淋巴结;膀胱根治性切除以及双侧的盆腔淋巴结清扫是膀胱癌的重要治疗手段。

关键词: 膀胱肿瘤, 肿瘤转移, 淋巴结, 膀胱切除术

Abstract: Objective:To investigate the characteristics and related influence factors of lymph node metastases in patients undergoing radical cystectomy and lymph node dissection for bladder cancer. Methods: The data of 522 patients who underwent radical cystectomy and pelvic lymph node dissection at Department of Urology, Peking University First Hospital from 1998 to 2012, were retrospectively collected, and the lymph node mapping was performed in all the patients to determine the location of metastatic lymph nodes.Results: For the 522 patients with bladder cancer, lymph node metastasis occurred in 99 patients, and the incidence of lymph node metastasis was 19.0%. The incidence at different tumor stages was: 3.7% in T1 (6/164), 10.5% in T2 (17/160), 36.7% in T3(40/107), and 41.9% in T4 (36/86). The most common involved lymph nodes were hypogastric/obturator lymph nodes (77/99, 77.8%) and external iliac lymph nodes (35/99, 35.4%). The mean number of lymph nodes dissected was 11.6 (1-51). The lymph node density (number of lymph nodes involved/number of lymph nodes removed) was 44.1%. The incidence of lymph node metastasis was statistical related to tumor stage (P<0.01,OR 2.71,95% CI 2.13-3.44) and tumor grade (P<0.01,OR 3.81,95% CI 1.66-8.74), while age, gender, smoke history, and weight had no statistical significance. Conclusion:Lymph node metastasis is the most common metastasis route of bladder cancer. The incidence of lymph node tumor involvement is correlated with increasing tumor stage and tumor grade. The most common involved lymph nodes are hypogastric/obturator lymph nodes and external iliac lymph nodes. Radical cystectomy and bilateral pelvic lymph nodes dissection are of great significance in the treatment of bladder cancer.

Key words: Urinary bladder neoplasms, Neoplasm metastasis, Lymph nodes, Cystectomy

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