淋巴结密度是接受腹膜后淋巴结清扫术的患者复发的预后指标。

IF 2.4 3区医学 Q3 ONCOLOGY

Urologic Oncology-seminars and Original Investigations Pub Date : 2024-08-26 DOI:10.1016/j.urolonc.2024.07.012

Julian Chavarriaga M.D. , Ahmad Mousa M.D., F.R.C.S.C. , Eshetu G. Atenafu M.Sc. , Lynn Anson-Cartwright , Carley Langleben , Michael Jewett M.D., F.R.C.S.C. , Robert J. Hamilton MD., M.P.H., F.R.C.S.C.

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引用次数: 0

摘要

简介：原发性腹膜后淋巴结清扫术（primary retroperitoneal lymph node dissection，ppRPLND）是临床 II 期睾丸生殖细胞瘤（testicular germ cell tumors，TGCTs）和腹膜后复发的 I 期睾丸生殖细胞瘤的一种治疗方法。在 pRPLND 期间提高原始淋巴结产量与降低复发风险有关。然而，由于手术模板和标本处理方法的不同，这一指标存在局限性。我们的目的是评估淋巴结密度（LND），即阳性淋巴结与切除的结节总数之比，作为 pRPLND 后复发的预后指标：我们回顾了1990年至2022年间在玛格丽特公主癌症中心接受pRPLND的所有患者。主要终点是无复发生存期（RFS）。RFS采用Kaplan-Meier乘积限值法计算。对数秩检验用于评估LND的影响，递归二元分区法用于确定可提供最佳RFS分离的LND阈值：在这项研究中，178名患者接受了pRPLND治疗。共有 137 例（77%）患者有结节转移的病理证据，其中 96 例采用开放式 RPLND 治疗，41 例采用机器人 RPLND 治疗。切除淋巴结的中位数为 32 个（IQR 23-43），阳性淋巴结总数的中位数为 2 个（IQR 1-36）。这意味着中位 LND 为 3.1%（IQR 1.7-57.1）。机器人和开放式方法的 LND 无明显差异（P = 0.6664）。中位随访 38.6 个月后，11 名患者（8.02%）复发。LND与复发无明显相关性（HR 1.018，95% CI，0.977-1.061）。对LND进行二分法的最佳阈值是≥26.75%，该阈值可使RFS达到最佳分离效果，但未达到统计学意义（P = 0.0651）：总之，LND与TGCTs患者pRPLND后的RFS无关。TGCT的独特性和其他既定风险因素的存在限制了LND单独预测复发的效用。

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Lymph node density as a prognostic marker of relapse in patients who underwent primary retroperitoneal lymph node dissection

Introduction

Primary retroperitoneal lymph node dissection (pRPLND) is a treatment option for clinical stage (CS) II testicular germ cell tumors (TGCTs) and CS I with retroperitoneal relapse. Increasing raw lymph node yield during pRPLND has been associated a decreased relapse risk. However, this metric has limitations due to variations in surgical templates and specimen processing methods. We aimed to evaluate the lymph node density (LND), which is the ratio of positive lymph nodes to the total number of nodes removed, as a prognostic marker for relapse after pRPLND.

Methods

We reviewed all patients who underwent pRPLND at the Princess Margaret Cancer Centre between 1990 and 2022. The primary endpoint was relapse-free survival (RFS). RFS was calculated using the Kaplan-Meier product-limit method. The log-rank test was used to assess the impact of LND, and recursive binary partitioning was used to determine the threshold LND that provides optimum separation in RFS.

Results

In this study, 178 patients were treated with pRPLND. A total of 137 (77%) patients had pathological evidence of nodal metastasis, 96 were treated with open RPLND, and 41 with robotic RPLND. The median number of lymph nodes harvested was 32 (IQR 23–43) and median total positive nodes was 2 (IQR 1–36). This translated into a median LND of 3.1% (IQR 1.7–57.1). There was no significant difference in the LND between robotic and open approaches (P = 0.6664). After a median follow-up of 38.6 months, 11 patients (8.02%) had relapsed. LND was not significantly associated with relapse (HR 1.018, 95% CI, 0.977–1.061). The optimal threshold to dichotomize LND that provides optimum separation in RFS was ≥ 26.75%, however, it did not reach statistical significance (P = 0.0651).

Conclusion

In conclusion, the LND was not associated with RFS after pRPLND in patients with TGCTs. The unique characteristics of TGCTs and the presence of other established risk factors limit the utility of the LND alone in predicting relapse.

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来源期刊

Urologic Oncology-seminars and Original Investigations 医学-泌尿学与肾脏学

CiteScore

4.80

自引率

3.70%

发文量

297

审稿时长

7.6 weeks

期刊介绍： Urologic Oncology: Seminars and Original Investigations is the official journal of the Society of Urologic Oncology. The journal publishes practical, timely, and relevant clinical and basic science research articles which address any aspect of urologic oncology. Each issue comprises original research, news and topics, survey articles providing short commentaries on other important articles in the urologic oncology literature, and reviews including an in-depth Seminar examining a specific clinical dilemma. The journal periodically publishes supplement issues devoted to areas of current interest to the urologic oncology community. Articles published are of interest to researchers and the clinicians involved in the practice of urologic oncology including urologists, oncologists, and radiologists.