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.
{"title":"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。","authors":"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.","doi":"10.1016/j.urolonc.2024.07.012","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>P</em> = 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 (<em>P</em> = 0.0651).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"42 12","pages":"Pages 455.e1-455.e8"},"PeriodicalIF":2.4000,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Lymph node density as a prognostic marker of relapse in patients who underwent primary retroperitoneal lymph node dissection\",\"authors\":\"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.\",\"doi\":\"10.1016/j.urolonc.2024.07.012\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>P</em> = 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). 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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.
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.
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