不同病理分级分期膀胱癌淋巴结转移的分布状态：208例根治性膀胱切除连续病例分析  

Distribution of positive lymph nodes of muscle invasive bladder cancer： analysis the pathological data from 208 consecutive cases of radical cystectomy

作　　者：申克辉[1] 虞巍[1] 张凯[1] 郭应禄[1] 何群[1] 席志军[1] 

机构地区：[1]北京大学第一医院泌尿外科 北京大学泌尿外科研究所,100034

出　　处：《中华泌尿外科杂志》2010年第2期99-103,共5页Chinese Journal of Urology

基　　金：国家自然科学基金项目资助（30571853,30872588）

摘　　要：目的了解肌层侵犯膀胱癌的病理分级分期与淋巴结转移的关系及不同分期阳性淋巴结的分布状况。方法回顾性分析2006年1月1日至2009年7月31日行根治性膀胱切除的208例膀胱移行上皮细胞癌连续病例。男182例，女26例。平均年龄65岁。统计分析肿瘤淋巴结转移和病理特点的关系。结果208例中，根据WHO1973年分级标准，G2 55例（26．4％）、G3 153例（73．6％），病理分期T1 59例（28．4％）、T2 58例（27．8％）、T3 48例（23．0％）、T4 43例（20．6％）。病理分级和分期呈正相关，r=0．392，P〈0．001。其中行淋巴清扫151例，T3、T4淋巴结阳性比例显著高于T1病例（P=0．001，P=0．000），而T4淋巴结阳性比例显著高于T2病例（P=0．012）。阳性淋巴结主要分布在盆腔区域淋巴结。G2肿瘤淋巴结阳性1例（1．8％），G3 38例（24．8％）。随着病理分期增加，近端大血管周围淋巴结受累机会也随之升高。结论对于低分级分期肿瘤，由于淋巴结受累机会相对小，可以选择盆腔区域淋巴清扫；而对于高分级分期肿瘤，扩大淋巴清扫范围是必要的。Objective To describe the distribution of positive lymph nodes of muscle invasive bladder cancer, and explore the relationship between positive nodes and pathological characters. Methods Pathological data from 208 consecutive cases of muscle invasive bladder cancer were collect- ed and reviewed. The correlation of tumor grade, tumor stage and lymph nodes status was analyzed. The locations and numbers of positive nodes were recorded and compared according to the specific grade or stage. Results There were 153 cases （73.6%）of G3 tumor and 55 cases（26.4%） of G2 tumor and none G1 （0%）in this cohort. The case number from pT1 to pT4 was 59（28. 4%）,58 （27.8%）,48（23.0%）and 43（20.6%）, respectively. The tumor grade was positively correlated with tumor stage in this cohort （r=0.392, P=0.000）. 153 cases had been taken lymph node dissection. There was more node positive cases in pT3 and pT4 than that in T1 （P=0. 001 ,P=0. 000）, as well as pT4 compared with pT2 （P=0. 012）. The data showed that most of the positive nodes were located within the pelvic region. There was only 1 case and 1 node positive for G1/G2 tumor with 24.84% of node positive cases for G3. The positive nodes involved from pelvic to proximal artery while the stage increased. Conclusions There is less chance for low grade （G1/G2） bladder cancer to be node positive compared with G3 ones. It is necessary to take a extensive lymphadenectomy for the patients with stage more than T2.

关 键 词：膀胱肿瘤 癌 淋巴结清扫 分级 分期 

分 类 号：R737.14[医药卫生—肿瘤]