CAJ | 학술논문

目的：评价规范化盆腔淋巴结清扫对膀胱癌患者预后的影响作用，分析影响淋巴结转移的相关因素及淋巴结肿大与淋巴结转移两者的关系。方法：回顾性分析2008年1月至2013年7月天津医科大学肿瘤医院120例膀胱癌患者临床资料，分为盆腔淋巴结规范化清扫组58例，未规范化清扫组62例。分析淋巴结转移与病理分期、分级及术中触及肿大淋巴结的关系，探讨盆腔淋巴结清扫对预后的影响。结果：120例膀胱癌患者术后1、3、5年总生存率分别为84.0%、69.9%、57.9%。规范化盆腔淋巴结清扫组与未规范化清扫组的3年生存率分别为78.4%与46.2%（χ2=5.487，P=0.019）。淋巴结阳性与阴性患者术后3年生存率分别为50.0%与86.4%，（χ2=9.303，P=0.002）。术中触及肿大淋巴结与淋巴结转移具有相关性（P<0.001），病理分期、病理类型（尿路上皮癌及非尿路上皮癌）及年龄是患者预后的影响因素（P<0.05）。结论：术中触及肿大淋巴结与淋巴结转移相关，可预测淋巴结转移的发生，盆腔淋巴结清扫影响膀胱癌患者预后，阳性淋巴结是膀胱癌患者预后的独立危险因素，规范盆腔淋巴结清扫术可延长患者术后生存时间。
목적：평개규범화분강림파결청소대방광암환자예후적영향작용，분석영향림파결전이적상관인소급림파결종대여림파결전이량자적관계。방법：회고성분석2008년1월지2013년7월천진의과대학종류의원120례방광암환자림상자료，분위분강림파결규범화청소조58례，미규범화청소조62례。분석림파결전이여병리분기、분급급술중촉급종대림파결적관계，탐토분강림파결청소대예후적영향。결과：120례방광암환자술후1、3、5년총생존솔분별위84.0%、69.9%、57.9%。규범화분강림파결청소조여미규범화청소조적3년생존솔분별위78.4%여46.2%（χ2=5.487，P=0.019）。림파결양성여음성환자술후3년생존솔분별위50.0%여86.4%，（χ2=9.303，P=0.002）。술중촉급종대림파결여림파결전이구유상관성（P<0.001），병리분기、병리류형（뇨로상피암급비뇨로상피암）급년령시환자예후적영향인소（P<0.05）。결론：술중촉급종대림파결여림파결전이상관，가예측림파결전이적발생，분강림파결청소영향방광암환자예후，양성림파결시방광암환자예후적독립위험인소，규범분강림파결청소술가연장환자술후생존시간。
Objective:To evaluate the prognostic significance of standard pelvic lymphadenectomy on the disease-free survival (DFS) rate of bladder cancer patients undergoing radical cystectomy (RC) and to discuss the influencing factors of lymph node positivity and the relationship between positive lymph nodes and lymphadenectasis. Methods:This prospective analysis includes 120 cases of bladder cancer treated with pelvic lymphadenectomy and RC in Tianjin Medical University Cancer Institute and Hospital between 2008 and 2013. The cases were divided into two groups, namely, the standard pelvic lymphadenectomy group (Group A) and the nonstandard pelvic lymphadenectomy group (Group B). The relationships among positive lymph nodes, lymphadenectasis, tumor stage, and patho-logical grade were retrospectively analyzed. Results:The 1-, 3-, and 5-year overall survival rates of 120 patients were 84%, 69.9%, and 57.9%, respectively. Group A was significantly correlated with a better 3-year overall survival rate than Group B, i.e., 78.4%vs. 46.2%(P<0.05). Lymphadenectasis influenced the DFS rate of bladder cancer patients after RC with pelvic lymphadenectomy, i.e., 50.0%vs. 86.4%(χ2=9.303, P<0.05). Meanwhile, lymphadenectasis was positively correlated with lymph node positivity (P<0.001). Tumor stage, histological subtype (urothelial carcinoma and non-urothelial carcinoma), and age were the prognostic factors for bladder cancer (P<0.05). Conclusion:Intraoperative lymphadenectasis is the influencing factor of lymph node positivity. This study determined that standard pel-vic lymphadenectomy and lymphadenectasis may influence the DFS rate after RC and are the independent risk factors for the prognosis of bladder cancer. Creating evidence-based guidelines of standardized lymphadenectomy for further improvement of the surgical quali-ty and survival of bladder cancer patients is essential.