NDLI: Critical analysis and validation of lymph node density as prognostic variable in urothelial carcinoma of bladder.

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Critical analysis and validation of lymph node density as prognostic variable in urothelial carcinoma of bladder.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Kassouf, Wassim Svatek, Robert S. Shariat, Shahrokh F. Novara, Giacomo Lerner, Seth P. Fradet, Yves Bastian, Patrick J. Aprikian, Armen Karakiewicz, Pierre I. Fritsche, Hans Martin Dinney, Colin P. N. Tilki, Derya Kamat, Ashish M. Izawa, Jonathan I. Ficarra, Vincenzo Lotan, Yair Sagalowsky, Arthur I. Schoenberg, Mark P. Skinner, Eila C.
Description	Country affiliation: Canada Author Affiliation: Kassouf W ( McGill University Health Centre, Montréal, Quebec, Canada. wassim.kassouf@muhc.mcgill.ca)
Abstract	OBJECTIVE: To validate the prognostic relevance of lymph node density (LND) and identify its optimal cut-points in a large international multicenter series of patients treated with radical cystectomy (RC) for invasive bladder cancer. METHODS: From 1993 to 2005, 4,430 bladder cancer patients who underwent RC without neoadjuvant chemotherapy were reviewed; of these, 1,038 were pN+M0 disease and form the basis of this report. RESULTS: Median age of patients was 67 years with median follow-up in survivors of 33 months. Overall, 5-year DSS estimate was 36%. Median number of lymph nodes removed was 18 (IQR, 11-32), median number of positive lymph nodes was 2 (IQR, 1-5), and median LND was 14.3% (IQR, 6.67-33.3%). LND as continuous variable was a stronger prognostic factor for DSS in patients that underwent a more extensive PLND (P < 0.001). HR for inverse association of LND with DSS increased incrementally with increasing LND cut-points. Categorizing LND into quintiles revealed strong tertiary distribution of risk based on LND <6%, 6%-41%, or >41% with cumulative 5-year DSS of 47%, 36%, and 21%, respectively (P < 0.001). When patients were stratified by adjuvant chemotherapy, LND remains independently prognostic in patients who received adjuvant chemotherapy as well as those who did not. CONCLUSION: Lymph node density is prognostic in bladder cancer patients who undergo a more extensive PLND and remains prognostic even when adjuvant chemotherapy is used. Prognostic value of LND is best represented as a continuum of risk and LND <6% represents the best possible outcome in patients with nodal disease.
File Format	HTM / HTML
ISSN	10781439
Issue Number	4
Volume Number	31
e-ISSN	18732496
Journal	Urologic Oncology: Seminars and Original Investigations
Language	English
Publisher	Elsevier
Publisher Date	2013-05-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Urology Discipline Oncology Carcinoma In Situ Pathology Lymph Nodes Neoplasm Recurrence, Local Urinary Bladder Neoplasms Aged Mortality Surgery Cystoscopy Female Follow-up Studies Humans International Agencies Lymph Node Excision Lymphatic Metastasis Male Middle Aged Neoplasm Invasiveness Neoplasm Staging Prognosis Survival Rate Journal Article Multicenter Study
Content Type	Text
Resource Type	Article
Subject	Urology Oncology

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