방광 이행상피세포암에서의 림프절전이와 그에 따른 생존율 분석
The Analysis of Lymph Node Metastases and Survival Rates in Transitional Cell Carcinoma of Urinary Bladder
소속 상세정보
전동찬/Dong Chan Chun
강선중/김선일/정병하/홍성준/양승철/이진무/Sun Joong Kang/Sun Il Kim/Byung Ha Chung/Sung Joon Hong/Seung Choul Yang/Jin Moo Lee
KMID : 0358319980390121222
Abstract
서론
방광암은 비뇨기과 영역에서 가장 흔히 접하는 악성질환이며, 그 치료에는 수술요법, 방사
선조사요법, 항암화학요법, 면역요법 등이 있다. 그러나 근치적 방광적출술시 이미 국소 림
프절로의 현미경적 전이를 동반하고 있는 경우가 많아 그 예후는 좋지 않다 이러한 근치적
방광적출술시 암세포가 주위 림프절에 전이되어 있을 가능성은 약 15-25%이며, 이는 원발
병소의 병기에 비례한다. 이러한 국소 림프절전이는 병의 진행 및 생존율에 많은 영향을 미
치는 것으로 보고되고 있다. 그러나 현재의 방사선학적 진단 방법으로는 수술전에 국소 림
프절의 전이 여부를 정확히 알 수는 없다. 국소 림프절전이가 있는 방광암 환자에 있어서
방광적출술과 골반림프절절제술의 효과에 대해서는 지금까지 많은 논란이 있으나, 일부 환
자에서 생존율의 연장이 보고되고 있다. 따라서 저자들은 근치적 방광적출술과 골반림프절
절제술 후 병리학적으로 림프절전이가 증명된 환자를 대상으로 병리학적 병기 및 분화도 등
의 변수에 따른 림프절전이의 가능성과 림프절전이가 생존율에 미치는 영향에 대하여 알아
보고자 하였다.
#초록#
Purpose : The incidence of lymph node metastases in patients undergoing radical
cystectomy varies between 15% and 25%, and is related to the depth of invasion of
primary tumor. Pelvic lymphadenectomy provides accurate staging information as well as
therapeutic benefit in a selected group of patients without increased morbidity. We
analyzed the incidence of lymph node metastases and survival rates in the patients with
pathologically proven lymph node metastases to reassess the role of pelvic
lymphadenectomy in the patients with transitional cell carcinoma of urinary bladder.
Materials and Methods : We retrospectively reviewed the medical records of 215
patients with transitional cell carcinoma treated by radical cystectomy and pelvic
lymphadenectomy from 1976 to 1996 who were followed for a mean 31.7 months and
analyzed the incidence of pathologically proven lymph node metastases and survival
rates according to pathological stage, histologic grade and cell morphology.
Results : Patient distribution according to pathological stage was 18 for
pTa, 51 pT1, 44
pT2 36 pT3a, 42
pT3b, and 24 pT4. Mean follow
up was 31.7 months. The overall 5-year survival rate was 67.9%. The 5-year survival
rates according to pathological stage were 93.6% for pTa and
pT1, 72.4% pT2, 47.2%
pT3a, 52.2% pT3b, 49.6%
pT4 The 5-year survival rates according to histologic grade
were 100.0% for grade Ⅰ, 80.1% grade Ⅱ, 57.0% grade Ⅲ. The overall incidence of
lymph node metastases was 14%(30/215). The 5-year survival rates according to lymph
nodes metastases were 72.5% for pN0, 30.3%
pN1 and the 2-year survival rate was 41.5% for
pN2. The incidence of lymph node metastases was 0% for
pTa and pT1, 2.3%
pT2, 11.1% pT3a, 38.1%
pT3b, 37.5% pT4 and 0% for
grade Ⅰ, 7.2% grade Ⅱ, 19.0% grade Ⅲ. The 5-year survival rates according to
pathological stage and lymph nodes metastases were 75.9% for
pT3a or less with pN0,58.4% for
pT3b or more with pN0, 26.7%
for pT3b or more with pN1 or
pN2.
Conclusions : Lymph node metastases was a significant prognostic factor for
transitional cell carcinoma of the urinary bladder. The incidence of lymph node
metastases increased as pathological stage and histologic grade increased. Radical
cystectomy with pelvic lymphadenectomy might be beneficial for a few patients with
bladder confined tumor with lymph node metastases. Adjuvant therapy is recommended
for transitional cell carcinoma of the urinary bladder with lymph node metastases for
improved survival.
Transitional cell carcinoma; Urinary bladder; Lymph node metastases; Radical cystectomy; Pelvic lymphadenectomy;
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