背景:一项前瞻性随机试验(LEAAUOAB25/02)发现,在接受根治性膀胱切除术(RC)的膀胱癌(BCa)患者中,与有限的盆腔淋巴结清扫术(PLND)模板相比,延长的患者没有生存获益。然而,标准模板和扩展模板的淋巴结浸润率(LNI)低于估计.
目的:评估术前临床和病理参数预测LNI的准确性,并建立模型以术前选择扩展PLND模板的候选者。
方法:回顾性分析了在单一机构治疗的903例BCa患者。主要结果是确定术前LNI的风险以定制PLND的类型。扩展的PLND模板包括切除盆腔淋巴结和髂总淋巴结,骶前,主动脉腔旁,主动脉腔,和肠系膜下动脉的腔旁部位。
方法:总共903例BCa患者接受RC和双侧延伸PLND模板治疗。
■使用接收器工作特征曲线下面积(AUC)评估了预测LNI的几种模型,校准图和决策曲线分析。开发并在内部验证了预测扩展模式中的LNI的列线图。
结论:总体而言,55例患者(6.1%)在RC的扩展PLND模板中有LNI。去除的节点的中位数为19(四分位间距:13-26)。包括年龄在内的模型,临床T分期,临床淋巴结分期,淋巴管浸润,并且在RC发生之前的最后一次经尿道切除术中存在原位癌。该模型的AUC为73%。使用3%的临界值,108个扩展PLND(12%)将被免除,只有两个LNI(3%)将被错过。我们模型的主要局限性是数据的回顾性,缺乏外部验证,和低LNI率。
结论:这是第一个在扩展的PLND模板中预测LNI的模型。该模型可能有助于泌尿科医师确定哪些患者可能在RC时受益于延长的PLND,为所有其他人保留标准的PLND。
■我们开发了第一个列线图来预测膀胱癌根治性膀胱切除术患者盆腔淋巴结清扫模板的淋巴结侵犯(LNI)。采用我们的模型来确定扩展的盆腔淋巴结清扫模板的候选者可以避免多达12%的这些程序,而只需错过3%的LNI患者。
BACKGROUND: A prospective randomized trial (LEA AUO AB 25/02) found no survival benefit in extended compared with limited pelvic lymph node dissection (PLND) templates in bladder cancer (BCa) patients treated with radical cystectomy (RC). However, the rate of lymph node invasion (LNI) in the standard and extended templates was lower than estimated.
OBJECTIVE: To assess the accuracy of preoperative clinical and pathological parameters to predict LNI and to develop a model to preoperatively select candidates for the extended PLND templates.
METHODS: A total of 903 BCa patients treated at a single institution were retrospectively identified. The primary outcome was to identify preoperatively the risk of LNI to tailor the type of PLND. The extended PLND templates consisted in the removal of pelvic lymph nodes together with the common iliac, presacral, para-aortocaval, interaortocaval, and paracaval sites up to the inferior mesenteric artery.
METHODS: A total of 903 BCa patients were treated with RC and bilateral extended PLND templates.
UNASSIGNED: Several models predicting LNI were evaluated using the area under the receiver operating characteristic curve (AUC), calibration plots and decision curve analyses. A nomogram predicting LNI in the extended pattern was developed and validated internally.
CONCLUSIONS: Overall, 55 patients (6.1%) had LNI in the extended PLND templates at RC. The median number of nodes removed was 19 (interquartile range: 13-26). A model including age, clinical T stage, clinical node stage, lymphovascular invasion, and presence of carcinoma in situ at the last transurethral resection before RC was developed. The AUC of this model is 73%. Using a cutoff of 3%, 108 extended PLNDs (12%) would be spared and only two LNIs (3%) would be missed. The main limitations of our model are the retrospective nature of the data, lack of external validation, and low rate of LNI.
CONCLUSIONS: This is the first proposed model to predict LNI in the extended PLND templates. This model might help urologists identify which patients might benefit from an extended PLND at the time of RC, reserving a standard PLND for all the others.
UNASSIGNED: We developed the first nomogram to predict lymph node invasion (LNI) in the extended pelvic lymph node dissection templates in bladder cancer patients treated with radical cystectomy. The adoption of our model to identify candidates for the extended pelvic lymph node dissection templates could avoid up to 12% of these procedures at the cost of missing only 3% of patients with LNI.