Pathologic nodal staging score for bladder cancer: A decision tool for adjuvant therapy after radical cystectomy Journal Article
| Authors: | Shariat, S. F.; Rink, M.; Ehdaie, B.; Xylinas, E.; Babjuk, M.; Merseburger, A. S.; Svatek, R. S.; Cha, E. K.; Tagawa, S. T.; Fajkovic, H.; Novara, G.; Karakiewicz, P. I.; Trinh, Q. D.; Daneshmand, S.; Lotan, Y.; Kassouf, W.; Fritsche, H. M.; Chun, F. K.; Sonpavde, G.; Joual, A.; Scherr, D. S.; Gonen, M. |
| Article Title: | Pathologic nodal staging score for bladder cancer: A decision tool for adjuvant therapy after radical cystectomy |
| Abstract: | Background: Radical cystectomy (RC) with pelvic lymph node dissection (PLND) is the standard of care for high-risk non-muscle-invasive and muscle-invasive bladder cancer (BCa). Objective: To develop a model that allows quantification of the likelihood that a pathologically node-negative patient has, indeed, no positive nodes. Design, setting, and participants: We analyzed data from 4335 patients treated with RC and PLND without neoadjuvant chemotherapy at 12 international academic centers. Interventions: Patients underwent RC and PLND. Outcome measurements and statistical analysis: We estimated the sensitivity of pathologic nodal staging using a beta-binomial model and developed a pathologic (postoperative) nodal staging score (pNSS) that represents the probability that a patient is correctly staged as node negative as a function of the number of examined nodes. Results and limitations: Overall, the probability of missing a positive node decreases with the increasing number of nodes examined (52% if 3 nodes are examined, 40% if 5 are examined, and 26% if 10 are examined). The proportion of having a positive node increased proportionally with advancing pathologic T stage and lymphovascular invasion (LVI). Patients with LVI who had 25 examined nodes would have a pNSS of 80% (pT1), 88% (pT2), and 66% (pT3-T4), whereas 10 examined nodes were sufficient for pNSS exceeding 90% in patients without LVI and pT0-T2 tumors. This study is limited because of its retrospective design and multicenter nature. Conclusions: We developed a tool that estimates the likelihood of lymph node (LN) metastasis in BCa patients treated with RC by evaluating the number of examined nodes, the pathologic T stage, and LVI. The pNSS indicates the adequacy of nodal staging in LN-negative patients. This tool could help to refine clinical decision making regarding adjuvant chemotherapy, follow-up scheduling, and inclusion in clinical trials. © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved. |
| Keywords: | survival; adult; aged; cancer surgery; major clinical study; histopathology; advanced cancer; cancer adjuvant therapy; postoperative care; cancer staging; outcome assessment; lymph node metastasis; lymph node dissection; pelvis lymph node; sensitivity analysis; retrospective study; bladder cancer; probability; adjuvant chemotherapy; lymph node; radical cystectomy; cystectomy; urothelial carcinoma; lymphovascular invasion; lymph vessel metastasis; pathologic nodal staging score |
| Journal Title: | European Urology |
| Volume: | 63 |
| Issue: | 2 |
| ISSN: | 0302-2838 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2013-02-01 |
| Start Page: | 371 |
| End Page: | 378 |
| Language: | English |
| DOI: | 10.1016/j.eururo.2012.06.008 |
| PROVIDER: | scopus |
| PUBMED: | 22727174 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 1 February 2013" - "CODEN: EUURA" - "Source: Scopus" |
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