BACKGROUND Perivesical lymph nodes (PVLNs) are occasionally isolated during grossing of cystectomy specimens. However, the prognostic implications of the involvement of PVLNs in bladder cancer patients, especially those with comparisons to pN0 disease, remain poorly understood. METHODS A retrospective review identified 115 radical cystectomy cases where PVLNs had been histologically assessed. These cases were then divided into 4 groups - Group 1 (n = 76): PVLN-negative/other pelvic lymph node (non-PVLN)-negative; Group 2 (n = 5): PVLN-positive/non-PVLN-negative; Group 3 (n = 17): PVLN-negative/non-PVLN-positive; and Group 4 (n = 17): PVLN-positive/non-PVLN-positive. RESULTS pT stage at cystectomy was significantly higher in Group 3 (P = 0.013), Group 4 (P < 0.001), Groups 2 and 4 (P < 0.001), or Groups 2-4 (P < 0.001) than in Group 1. However, the number of positive PVLNs (mean: 1.8 vs. 2.1; P = 0.718) or the rate of extracapsular extension in the PVLNs (40% vs. 65%, P = 0.609) was not significantly different between Group 2 and Group 4. Kaplan-Meier analysis and log-rank test revealed significantly (P < 0.05) higher risks of disease progression (Group 3/Group 4), cancer-specific mortality (Group 2/Group 3/Group 4), and overall mortality (Group 4), compared with Group 1. Multivariate analysis further showed metastasis to both PVLN and non-PVLN (Group 4), PVLN (Groups 2 and 4), or PVLN and/or non-PVLN (Groups 2-4) as an independent prognosticator for cancer-specific mortality and overall survival. There were also insignificant (P = 0.096) and significant (P = 0.036) differences in cancer-specific survival and overall survival, respectively, between Group 3 versus Group 4, and the trend of the latter was confirmed by subset multivariate analysis (hazard ratio = 3.769; P = 0.099). CONCLUSIONS Worse prognosis was observed in bladder cancer patients with isolated PVLN metastasis (vs. pN0 disease especially for cancer-specific survival), PVLN metastasis with or without non-PVLN metastasis (vs. pN0 disease), and concurrent PVLN and non-PVLN metastases (vs. PVLN-negative/non-PVLN-positive disease especially for overall survival). These findings indicate the importance of thorough histopathological assessment of PVLNs in radical cystectomy specimens.

中文翻译：

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淋巴结转移对膀胱癌行根治性膀胱切除术患者临床结局的影响。

背景技术在膀胱切除术标本的肉眼观察过程中，有时会分离出淋巴结淋巴结（PVLN）。然而，PVLNs参与膀胱癌患者，特别是那些与pN0疾病比较的患者，对预后的影响仍然知之甚少。方法回顾性研究确定了115例行根治性膀胱切除术的患者，其中PVLNs已通过组织学评估。然后将这些病例分为4组-第1组（n = 76）：PVLN阴性/其他盆腔淋巴结（非PVLN）阴性；第2组（n = 5）：PVLN阳性/非PVLN阴性；第3组（n = 17）：PVLN阴性/非PVLN阳性；第4组（n = 17）：PVLN阳性/非PVLN阳性。结果膀胱切除术的pT分期在第3组（P = 0.013），第4组（P <0.001），第2和第4组（P <0.001）或第2-4组（P <0.001）显着高于第1组。但是，第2组和第4组之间PVLNs阳性的数量（平均值：1.8 vs. 2.1； P = 0.718）或PVLNs的囊外扩张率（40％vs. 65％，P = 0.609）没有显着差异。 。Kaplan-Meier分析和对数秩检验表明，疾病进展（第3组/第4组），癌症特异性死亡率（第2组/第3组/第4组）和总体死亡率（第2组）的风险显着（P <0.05） 4），与第1组相比。多变量分析进一步显示，PVLN和非PVLN（第4组），PVLN（第2和第4组）或PVLN和/或非PVLN（第2-4组）均有转移癌症特异性死亡率和总生存率的预后指标。第3组与第4组之间，在癌症特异性存活率和总体存活率上分别没有显着差异（P = 0.096）和显着（P = 0.036）。后者的趋势已通过子集多元分析得到了确认（危险比= 3.769； P = 0.099）。结论在患有孤立的PVLN转移（vs. pN0疾病，尤其是针对癌症特异性生存），有或没有非PVLN转移（vs. pN0疾病），并发PVLN和非PVLN转移的膀胱癌患者中观察到更差的预后（相对于PVLN阴性/非PVLN阳性疾病，尤其是对于整体生存而言）。这些发现表明，彻底根治性膀胱切除术标本中PVLN的彻底组织病理学评估的重要性。PVLN转移伴有或不伴有非PVLN转移（相对于pN0疾病），以及同时发生的PVLN和非PVLN转移（相对于PVLN阴性/非PVLN阳性疾病，尤其是对于整体生存）。这些发现表明，彻底根治性膀胱切除术标本中PVLN的彻底组织病理学评估的重要性。PVLN转移伴有或不伴有非PVLN转移（相对于pN0疾病），以及同时发生的PVLN和非PVLN转移（相对于PVLN阴性/非PVLN阳性疾病，尤其是对于整体生存）。这些发现表明，彻底根治性膀胱切除术标本中PVLN的彻底组织病理学评估的重要性。