The Effect Of Lymph Node Dissection On The Survival Rate Of Patients With Advanced Renal Cell Carcinoma

Objective To investigate the influence of lymph node dissection on the survival rate of patients with advanced renal carcinoma and provide evidence for lymphadenectomy in advanced renal carcinoma.Methods Collected urology of the Second Affiliated Hospital of Nanhua University From January 2006 to December 2016,all patients are diagnosed with advanced renal cell carcinoma and with Surgical treatment,The collected data included: age,sex,surgical approach,TNM stage,Fuhrman grade,and overall survival(OS),disease-free survival(PFS),recurrence and metastasis,intraoperative blood loss,postoperative blood transfusion,creatinine changes,etc.Follow-up methods include: telephone,out-patient follow-up and visits.Lymph node dissection was divided into simple nephrectomy,radical nephrectomy(regional lymph node dissection)and radical nephrectomy+ expanded lymph node dissection.Results A total of 75 eligible patients with advanced renal carcinoma were enrolled in this study through our hospital case system,49 cases were male(65.3%)and 26 cases were female(34.7%).All patients ranged from 24 to 77 years old,with an average age of 55.45 ± 11.73,49 cases less than 60 years old and 26 cases older than 60 years old.In different TNM staging,there were 59 cases o f locally advanced renal cell carcinoma(T1N1M0,T2N1M0,T3aN1M0 and T3aN0M0)in Locally advanced renal cell carcinoma,and 16 cases of metastatic re nal cell carcinoma(T4N0M0 and T1-4N0-1M1).Fuhrman grading statistics,including 31 cases of well-differentiated group,moderately differentiated group of 21 cases,poorly differentiated group of 7 cases,unrecorded Furhman classificat ion cases in 16 cases.During the follow-up period,41 cases of recurrence or me tastasis and 34 cases of non-recurrence were found.Postoperative blood transfu sion: 35 cases,40 cases without blood transfusion;Postoperative pulmonary infe ction,atelectasis,ascites,lymphatic leakage and other complications in 13 cases(17.3%).The overall survival of all patients ranged from 7 months to 117 month s with a median survival of 32 months.Disease progression-free survival of 1 m onth-117 months,the median progression-free disease was 97 months.The radi cal nephrectomy+enlarged lymph node dissection group and the radical nephrec tomy group(regional lymph node dissection)were compared with the simple ne phrectomy group,the intraoperative hemorrhage was higher than that of the sim ple nephrectomy group(P<0.05),with statistically significant difference.There was no statistically significant difference in postoperative complications,postop erative blood transfusion and creatinine between the simple nephrectomy,radica l nephrectomy group(regional lymph node dissection)and the radical nephrecto my+enlarged lymph node dissection group(p> 0.05).The mean survival time of all patients with advanced renal cell carcinoma was 55.4 months.The mean sur vival time was 45.4 months in the simple nephrectomy group.The mean surviva l time was 71.0 months in the radical nephrectomy group(regional lymph node dissection).The mean survival time of the radical nephrectomy+enlarged lymph node dissection group was 97.6 months.The survival analysis showed that the s urvival time of radical nephrectomy + enlarged lymph node dissection group wa s better than that of radical nephrectomy group(regional lymph node dissection).The survival time of both groups was significantly better than that of simple ne phrectomy group(X2 = 18.630,P < 0.001).Multivariate survival analysis show ed that TNM stage,Fuhrman grade,and lymph node dissection all affected the s urvival time of kidney cancer patients.Conclusions 1,In patients with advanced renal carcinoma,the total survival time of lymph node dissection was higher than that in simple nephrectomy group.2,For patients with locally advanced renal cell carcinoma,the survival time of radical nephrectomy+extended lymph node dissection was better than that of radical nephrectomy(regional lymph node dissection)and simple nephrectomy group.The survival time of radical nephrectomy(regional lymph node dissection)was better than that of simple nephrectomy group.3,For patients with advanced renal carcinoma,although lymphadenectomy helps to improve the overall survival time,but this study found that intraoperative hemorrhage was higher than the group of simple nephrectomy.4,Univariate analysis showed that age,gender had no effect on the survival rate of renal carcinoma.Multivariate survival analysis showed that TNM staging,Fuhrman classification and lymph node dissection can affect the survival time of patients with renal cell carcinoma.