膀胱癌行根治性切除淋巴清扫范围

Objective

To compare extended pelvic lymph node dissection

(ePLND) with non-extended pelvic lymph node dissection

(non-ePLND) and assess their influence on recurrence-free

survival (RFS) in patients undergoing radical cystectomy for

bladder cancer.

Methods

Through a comprehensive search of the PubMed, Embase

and Cochrane Library databases in September 2012, we

performed a systematic review and cumulative

meta-analysis of all comparative studies assessing the extent

of pelvic lymph node dissection (PLND) and its influence

on RFS.

Results

Six studies with a total of 2824 patients were identified.

Overall analysis showed a significantly better RFS rate in

patients who had undergone ePLND than in those who

had undergone non-ePLND (hazard ratio [HR]: 0.65;

P < 0.001).

A subgroup analysis found that, compared with

non-ePLND, ePLND was associated with a better RFS rate

for both patients with negative lymph nodes (HR: 0.68; P =

0.007) and those with positive lymph nodes (HR: 0.58; P <

0.001).When stratified by pathological T stage, ePLND

provided additional RFS benefits for patients with pT3–4

disease (HR: 0.61; P < 0.001), but not for patients with ≤pT2

disease (HR: 0.95; P = 0.81).

Conclusions

results of this meta-analysis indicate that ePLND

provides a RFS benefit compared with non-ePLND. On

subgroup analysis, ePLND provides better RFS not only for

patients who had positive lymph nodes and pT3–4 disease,

but also for patients with negative lymph nodes.

Two randomized controlled trials on ePLND vs non-ePLND

are awaited which should provide more clinically

meaningful results.

Keywords

urinary bladder neoplasms, cystectomy, lymph node

dissection, systematic review