Kassouf, Wassim and Svatek, Robert S. and Shariat, Shahrokh F. and Novara, Giacomo and Lerner, Seth P. and Fradet, Yves and Bastian, Patrick J. and Aprikian, Armen and Karakiewicz, Pierre I. and Fritsche, Hans Martin and Dinney, Colin P. N. and Tilki, Derya and Kamat, Ashish M. and Izawa, Jonathan I. and Ficarra, Vincenzo and Lotan, Yair and Sagalowsky, Arthur I. and Schoenberg, Mark P. and Skinner, Eila C. (2013) Critical analysis and validation of lymph node density as prognostic variable in urothelial carcinoma of bladder. UROLOGIC ONCOLOGY-SEMINARS AND ORIGINAL INVESTIGATIONS, 31 (4). pp. 480-486. ISSN 1078-1439,
Full text not available from this repository. (Request a copy)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. (C) 2013 Elsevier Inc. All rights reserved.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | RADICAL CYSTECTOMY; PELVIC LYMPHADENECTOMY; CANCER; DISEASE; NUMBER; Bladder cancer; Lymph node density; Cystectomy; Adjuvant chemotherapy; lymphadenectomy |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Urologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 15 Apr 2020 13:12 |
| Last Modified: | 15 Apr 2020 13:12 |
| URI: | https://pred.uni-regensburg.de/id/eprint/16732 |
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