Lymph node-positive bladder cancer treated with radical cystectomy and lymphadenectomy: Effect of the level of node positivity Journal Article


Authors: Tarin, T. V.; Power, N. E.; Ehdaie, B.; Sfakianos, J. P.; Silberstein, J. L.; Savage, C. J.; Sjoberg, D.; Dalbagni, G.; Bochner, B. H.
Article Title: Lymph node-positive bladder cancer treated with radical cystectomy and lymphadenectomy: Effect of the level of node positivity
Abstract: Background: The extent of lymphadenectomy needed to optimize oncologic outcomes after radical cystectomy (RC) for patients with regionally advanced bladder cancer (BCa) is unclear. Objective: Evaluate the effect of the location of lymph node metastasis on recurrence-free survival (RFS) and cancer-specific survival (CSS) for patients undergoing RC with a mapping pelvic lymph node dissection (PLND). Design, setting, and participants: A study of 591 patients undergoing RC with mapping PLND was completed between 2000 and 2010. Median follow-up was 30 mo. Intervention: RC with mapping PLND. Measurements: We evaluated the impact of lymph node involvement by location on disease outcomes using the 2010 TNM staging system. Survival estimates were described using Kaplan-Meier methods. Gender, age, pathologic stage, histology, number of positive nodes, location of positive nodes, node density, use of perioperative chemotherapy, and grade were evaluated as predictors of RFS and CSS using multivariate Cox proportional hazard regression. Results and limitations: Overall, 114 patients (19%) had lymph node involvement, and 42 patients (7%) had pN3 disease. On multivariate analysis, the number of positive lymph nodes (one or two or more) was significantly associated with increased risk of cancer-specific death (hazard ratio [HR]: 1.9 [95% confidence interval (CI), 1.04-3.46], p = 0.036; versus HR: 4.3 [95% CI, 2.25-8.34], p < 0.0005). Positive lymph node location was not an independent predictor of RFS or CSS. Five-year RFS for pN3 patients undergoing RC with PLND was 25% (95% CI, 10-42). This finding was not statistically different from our pN1 and pN2 patients (38% [95% CI, 22-54] and 35% [95% CI, 11-60], respectively). This study is limited by the lack of prospective randomization and a control group. Conclusions: The outcome for patients with involved common iliac lymph nodes was similar to the outcome for patients with primary nodal basin disease. These data support inclusion of the common iliac lymph nodes (pN3) in the nodal staging system for BCa. Lymph node location was not an independent predictor of outcome, whereas the number of positive lymph nodes was an independent predictor of worse oncologic outcome (pN1, pN2). Further refinements of the TNM system to provide improved prognostication are warranted. © 2012 European Association of Urology.
Keywords: adult; cancer survival; human tissue; treatment outcome; aged; disease-free survival; middle aged; cancer surgery; major clinical study; histopathology; cancer localization; cancer adjuvant therapy; cancer patient; cancer staging; outcome assessment; follow up; follow-up studies; lymph node metastasis; antineoplastic agent; pelvis lymph node; lymph nodes; lymphatic metastasis; lymph node excision; prospective studies; pelvis lymphadenectomy; bladder cancer; urinary bladder neoplasms; cancer mortality; age; risk assessment; disease severity; cystectomy; carcinoma; sex difference; perioperative period; recurrence free survival; surgical patient; pelvic lymphadenectomy; neoplasm grading; tnm staging system
Journal Title: European Urology
Volume: 61
Issue: 5
ISSN: 0302-2838
Publisher: Elsevier Science, Inc.  
Date Published: 2012-05-01
Start Page: 1025
End Page: 1030
Language: English
DOI: 10.1016/j.eururo.2012.01.049
PROVIDER: scopus
PUBMED: 22342773
PMCID: PMC4035150
DOI/URL:
Notes: --- - "Export Date: 1 May 2012" - "CODEN: EUURA" - "Source: Scopus"
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MSK Authors
  1. Caroline Savage
    79 Savage
  2. Guido Dalbagni
    239 Dalbagni
  3. Daniel D. Sjoberg
    133 Sjoberg
  4. Behfar Ehdaie
    70 Ehdaie
  5. Bernard Bochner
    314 Bochner