Lymph node density is superior to TNM nodal status in predicting disease-specific survival after radical cystectomy for bladder cancer: Analysis of pooled data from MDACC and MSKCC Journal Article


Authors: Kassouf, W.; Agarwal, P. K.; Herr, H. W.; Munsell, M. F.; Spiess, P. E.; Brown, G. A.; Pisters, L.; Grossman, H. B.; Dinney, C. P.; Kamat, A. M.
Article Title: Lymph node density is superior to TNM nodal status in predicting disease-specific survival after radical cystectomy for bladder cancer: Analysis of pooled data from MDACC and MSKCC
Abstract: Purpose To compare the utility of lymph node density (LND) with TNM nodal status in predicting disease-specific survival (DSS) after radical cystectomy. Patients and Methods We identified 248 patients with nodal metastasis after radical cystectomy (without neoadjuvant chemotherapy): 162 patients from Memorial Sloan-Kettering Cancer Center (MSKCC) and 86 patients from M. D. Anderson Cancer Center (MDACC). We assessed the effect of several variables on DSS. Results After a median follow-up duration of 24 months, 134 patients died of their disease. The median DSS was 36 months, and the 1-year, 2-year, and 5-year DSS rates were 83.7%, 57.4%, and 36.6%, respectively. The median LND was 20%. The 5-year DSS rate was 54.6% for patients with LND <= 20% v 15.3% for patients with LND higher than 20% (P < .01). Pathologic nodal (pN) status in patients was 78 for pN1 (32%), 127 for pN2 (51%), and 43 for pN3 (17%). On univariate analysis, pN status and LND were significant predictors of DSS (P < .01). However, when pN status and LND were considered jointly in a multivariate model, only LND higher than 20% predicted decreased DSS (hazard ratio [HR], 2.75; P < .01). In addition, while nonorgan-confined (ie, > pT2) primary tumor (HR, 2.40; P < .01) and adjuvant chemotherapy (HR, 0.47; P < .01) were predictors of DSS, LND remained a predictor of DSS even after accounting for adjuvant chemotherapy. Conclusion LND is superior to TNM nodal status in predicting DSS for patients with lymph node-positive disease after radical cystectomy, even in the context of adjuvant chemotherapy.
Keywords: carcinoma; metastases; involvement; pelvic lymphadenectomy
Journal Title: Journal of Clinical Oncology
Volume: 26
Issue: 1
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2008-01-01
Start Page: 121
End Page: 126
Language: English
ACCESSION: WOS:000254176800023
DOI: 10.1200/jco.2007.12.9247
PROVIDER: wos
PUBMED: 18165646
Notes: --- - Article; Proceedings Paper - 102nd Annual Meeting of the American-Urological-Association - MAY 19-24, 2007 - Anaheim, CA - "Source: Wos"
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  1. Harry W Herr
    594 Herr