盆腔淋巴结大小对膀胱癌复发的影响  

Effect of pelvic lymph node size on recurrence of bladder cancer

作　　者：罗辉 熊珍珍 黄令杰 林山 李金雨[1] Luo Hui;Xiong Zhenzhen;Huang Lingjie;Lin Shan;Li Jinyu(Department of Urology,the 909th Hospital of the Chinese People's Liberation Army Joint Logistic Support Force(Dongnan Hospital of Xiamen University),Zhangzhou 363000,China)

机构地区：[1]中国人民解放军联勤保障部队第909医院(厦门大学附属东南医院)泌尿外科,福建漳州363000

出　　处：《中华腔镜泌尿外科杂志（电子版）》2023年第5期495-499,共5页Chinese Journal of Endourology(Electronic Edition)

基　　金：联勤保障部队第909医院青年苗圃基金(18Y007)。

摘　　要：目的按探讨盆腔淋巴结平均直径对无淋巴结转移肌层浸润性膀胱癌患者肿瘤复发的影响。方法回顾性分析联勤保障部队第九○九医院2012至2016年收治71例膀胱癌患者临床病理资料,根据随访结果,27例发生肿瘤复发,采用ROC受试工作者曲线分析盆腔淋巴结平均直径预测肿瘤复发最佳界值,分析入组患者盆腔淋巴结平均直径与临床病理学关系,单因素和Cox多因素分析肿瘤复发影响因素。结果淋巴结平均直径预测肿瘤复发的ROC曲线下面积(AUC)为0.749,最佳界值为0.675cm,95%CI为0.632~0.865,灵敏度为0.852,特异度为0.648;肿瘤分期T3、肿瘤低分化、脉管侵犯阳性、肿瘤复发的患者淋巴结平均直径增大(-2.021、-2.131、-2.569、-3.945,P<0.05);单因素分析发现肿瘤分期T3、肿瘤低分化、脉管侵犯阳性、淋巴结平均直径>0.675cm的患者肿瘤复发率较高(χ^(2)=23.608、3.968、12.776、8.925,P<0.05);多因素分析发现肿瘤分期T3和淋巴结平均直径>0.675cm是肿瘤复发的独立危险因素(95%CI-1.627~9.562、0.163~2.050,P<0.05)。结论无淋巴结转移肌层浸润性膀胱癌患者中盆腔淋巴结直径与肿瘤分期、分化和脉管侵犯相关,并且是肿瘤复发的独立危险因素,在判断预后和制定个体化治疗方案方面可能具有一定的临床意义。Objective To investigate the effect of mean pelvic lymph node diameter on tumor recurrence in patients with muscle-invasive bladder cancer without lymph node metastasis.Methods The clinicopathological data of 71 patients with bladder cancer treated in 909th Hospital of the Chinese People's Liberation Army Joint Logistic Support Force from 2012 to 2016 were retrospectively analyzed.According to the follow-up results,tumor recurrence occurred in 27 cases.The ROC author curve was used to analyze the optimal threshold for predicting tumor recurrence.The relationship between the mean diameter of pelvic lymph nodes and clinicopathology were analyzed.Univariate and Cox multivariate analysis of tumor recurrence factors.Results The area under ROC curve(AUC)was 0.749,the optimal limit of average lymph node diameter was 0.675 cm,95%CI was 0.632-0.865,sensitivity was 0.852,and specificity was 0.648.The mean diameter of lymph nodes increased in patients with tumor stage T3,poorly differentiated tumor,positive vascular invasion and tumor recurrence(t=-2.021,-2.131,-2.569,-3.945,P<0.05).Univariate analysis showed that patients with tumor stage T3,low tumor differentiation,positive vascular invasion and mean lymph node diameter>0.675 cm had a higher recurrence rate(χ^(2)=23.608,3.968,12.776,8.925,P<0.05).Multivariate analysis showed that T3 and mean lymph node diameter>0.675 cm were independent risk factors for tumor recurrence(95%Cl=1.627-9.562,0.163-2.050,P<0.05).Conclusions Pelvic lymph node diameter is associated with tumor stage,differentiation and vascular invasion in patients with muscle-invasive bladder cancer without lymph node metastasis,which is an independent risk factor for tumor recurrence and may have certain clinical significance in determining prognosis and formulating individualized treatment plan.

关 键 词：淋巴结 直径 膀胱肿瘤 复发 预后 

分 类 号：R737.14[医药卫生—肿瘤]