| [Objective]For a long time, when renal cell carcinoma underwent radical nephrectomy, whetherperformed lymph node dissection and the extent of dissection has been controversial. In the past10years, the number of lymph node dissection by urologists showed adeclining trend. This is mainly due to no study results could prove that the lymph nodedissection can certainly bring benefits for patients. In this retrospective study, wecollected and analyzed data of patients who be diagnosed with renal cell carcinoma andaccepted (or not to take) lymph node dissection in the First Affiliated Hospital of DalianMedical University from2003to2010. We compared the survival time of patients aftersurgery, in order to discuss the significance of lymph node dissection in renal cellcarcinoma.[Method]Through the electronic medical record system, We searched for radical nephrectomypatients data in the First Affiliated Hospital of Dalian Medical University from2003to2010. Then, we obtained1158cases. The selection criteria of follow up was that thepatient was pathologically diagnosed as renal cell carcinoma and underwent radicalnephrectomy. The exclusion criteria was that the patient was found to have othermalignant tumor on or before treatment, or have distant metastasis in the operationtherapy, or take targeted drug after operation. We selected TNM stage and pathologicalgrade which play the major influence on the prognosis as group index. The TNM stagewas according to the staging method published by AJCC in2010. Fuhrman gradeclassified Grade I, Grade II, and Grade I-II in pathology reports into " highdifferentiated " group; Grade III, Grade IV, Grade II-III, and Grade III-IV into“moderately-low differentiated†group. When operation record description to "resection/dissection regional lymph node, ranging from the crura of diaphragm to the beginningof the common iliac vessels" and "resection/dissection the lymph node aroundipsilateral great vascular" was taken as underwent lymph node dissection. We usedtelephone, letters, visits and other ways to got the overall survival (OS): the startingpoints were the operation date, the end points were the date of death from renal cellcarcinoma and progression free survival (PFS): the starting points were the operationdate, the end points were locoregional recurrence or distant metastasis found in renalcell carcinoma. [Results]A total of252cases were included in the study, including162male patients and90female patients, patients with an average age of58.23±11.96.140patients with lymphnode dissection, and112patients without lymph node dissection. The follow-up timewas1.2months to80.7months, average21.6months. The survival time was8monthsto134months, average67.2months, the median survival period of67months. Whetherperformed lymph node dissection, there was a difference in overall survival (p<0.01).Comparing patients (T1-2) and others (T3-4), whether performed lymph node dissectionwas no difference in progression-free survival (p=0.224), but there was a difference inoverall survival (p<0.01). Survival analysis showed the average survival time of T3-4patients was90.8months, with lymph node dissection was100.6months, withoutlymph node dissection was67.7months (p<0.05). Cox regression analysis showed thatlymph node dissection and Fuhrman grade were significant for survival time.[Conclusions]When renal cell carcinoma underwent radical nephrectomy, whether performed lymphnode dissection in pantients with stage of T1-2had no effect on the survival time.However, if patients with stage of T3-4were performed lymph node dissection, theycould get longer survival time. |
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