Lack of benefit from extended lymphadenectomy in muscle-invasive bladder cancer

IF 81.1 1区 医学 Q1 ONCOLOGY
Diana Romero
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引用次数: 0

Abstract

Patients with muscle-invasive bladder cancer (MIBC) typically undergo radical cystectomy with bilateral pelvic lymphadenectomy to achieve local disease control and identify pathological nodal metastases. The optimal extent of lymphadenectomy remains a matter of debate and many centres favour an extended approach, despite a lack of evidence from randomized trials. Now, results from the phase III SWOG S1011 trial demonstrate that standard lymphadenectomy provides similar survival outcomes and is safer than an extended procedure.

Patients with T2–4a N0–1 MIBC requiring radical cystectomy were randomly allocated to undergo standard (n = 300) versus extended (n = 292) bilateral pelvic lymphadenectomy. Standard pelvic lymphadenectomy involved removal of the external and internal iliac and obturator nodes. The extended procedure, in addition, involved removal of the common iliac nodes, node-bearing tissue in the presciatic region and presacral nodes. Surgeries were carried out by 36 surgeons who had performed ≥50 radical cystectomies in the previous 3 years and worked in high-volume centres (≥30 such procedures per year). Disease-free survival (DFS) was the primary end point.

肌肉浸润性膀胱癌的扩大淋巴结切除术缺乏益处
肌层浸润性膀胱癌(MIBC)患者通常会接受根治性膀胱切除术和双侧盆腔淋巴结切除术,以达到局部疾病控制和确定病理结节转移的目的。淋巴结切除的最佳范围仍是一个争论不休的问题,尽管缺乏随机试验的证据,但许多中心仍倾向于采用扩大切除范围的方法。现在,III期SWOG S1011试验的结果表明,标准淋巴结切除术可提供相似的生存结果,而且比扩大手术更安全。需要进行根治性膀胱切除术的T2-4a N0-1 MIBC患者被随机分配接受标准(n = 300)和扩大(n = 292)双侧盆腔淋巴结切除术。标准盆腔淋巴结切除术包括髂内外结节和钝结节切除。扩展手术则需要切除髂总结节、骶前区域的结节组织和骶前结节。手术由36名外科医生实施,他们在过去3年中实施了≥50例根治性膀胱切除术,并在高产量中心工作(每年此类手术≥30例)。无病生存期(DFS)是主要终点。
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来源期刊
CiteScore
99.40
自引率
0.40%
发文量
114
审稿时长
6-12 weeks
期刊介绍: Nature Reviews publishes clinical content authored by internationally renowned clinical academics and researchers, catering to readers in the medical sciences at postgraduate levels and beyond. Although targeted at practicing doctors, researchers, and academics within specific specialties, the aim is to ensure accessibility for readers across various medical disciplines. The journal features in-depth Reviews offering authoritative and current information, contextualizing topics within the history and development of a field. Perspectives, News & Views articles, and the Research Highlights section provide topical discussions, opinions, and filtered primary research from diverse medical journals.
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