방광 이행상피세포암에서의 림프절전이와 그에 따른 생존율 분석

Abstract

Purpose: The incidence of lymph node metastases in patients undergoing radical cystectomy varies between 15% and 25%, and is related to the depth of invasion of primary tumor. Pelvic lymphadenectomy provides accurate staging information as well as therapeutic benefit in a selected group of patients without increased morbidity. We analyzed the incidence of lymph node metastases and survival rates in the patients with pathologically proven lymph node metastases to reassess the role of pelvic lymphadenectomy in the patients with transitional cell carcinoma of urinary bladder. Materials and Methods: We retrospectively reviewed the medical records of 215 patients with transitional cell carcinoma treated by radical cystectomy and pelvic lymphadenectomy from 1976 to 1996 who were followed for a mean 31.7 months and analyzed the incidence of pathologically proven lymph node metastases and survival rates according to pathological stage, histologic grade and cell morphology. Results: Patient distribution according to pathological stage was 18 for pTa, 51 pT1, 44 pT2, 36 pT3a, 42 pT3b, and 24 pT4. Mean follow up was 31.7 months. The overall 5-year survival rate was 67.9%. The 5-year survival rates according to pathological stage were 93.6% for pTa and pT1, 72.4% pT2, 47.2% pT3a, 52.2% pT3b, 49.6% pT4. The 5-year survival rates according to histologic grade were 100.0% for grade I, 80.1% grade II, 57.0% grade III. The overall incidence of lymph node metastases was 14%(30/215). The 5-year survival rates according to lymph nodes metastases were 72.5% for pN0, 30.3% pN1 and the 2-year survival rate was 41.5% for pN2. The incidence of lymph node metastases was 0% for pTa and pT1, 2.3% pT2, 11.1% pT3a, 38.1% pT3b, 37.5% pT4 and 0% for grade I, 7.2% grade II, 19.0% grade III. The 5-year survival rates according to pathological stage and lymph nodes metastases were 75.9% for pT3a or less with pN0, 58.4% for pT3b or more with pN0, 26.7% for pT3b or more with pN1 or pN2. Conclusions: Lymph node metastases was a significant prognostic factor for transitional cell carcinoma of the urinary bladder. The incidence of lymph node metastases increased as pathological stage and histologic grade increased. Radical cystectomy with pelvic lymphadenectomy might be beneficial for a few patients with bladder confined tumor with lymph node metastases. Adjuvant therapy is recommended for transitional cell carcinoma of the urinary bladder with lymph node metastases for improved survival.