Shariat, Shahrokh F. and Rink, Michael and Ehdaie, Behfar and Xylinas, Evanguelos and Babjuk, Marek and Merseburger, Axel S. and Svatek, Robert S. and Cha, Eugene K. and Tagawa, Scott T. and Fajkovic, Harun and Novara, Giacomo and Karakiewicz, Pierre I. and Quoc-Dien Trinh, and Daneshmand, Siamak and Lotan, Yair and Kassouf, Wassim and Fritsche, Hans-Martin and Chun, Felix K. and Sonpavde, Guru and Joual, Abdennabi and Scherr, Douglas S. and Gonen, Mithat (2013) Pathologic Nodal Staging Score for Bladder Cancer: A Decision Tool for Adjuvant Therapy After Radical Cystectomy. EUROPEAN UROLOGY, 63 (2). pp. 371-378. ISSN 0302-2838,
Full text not available from this repository. (Request a copy)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. (C) 2012 European Association of Urology. Published by Elsevier B. V. All rights reserved.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | TRANSITIONAL-CELL CARCINOMA; LYMPH-NODES; LYMPHOVASCULAR INVASION; PELVIC LYMPHADENECTOMY; MINIMUM NUMBER; SURVIVAL; IMPACT; METASTASIS; RECURRENCE; DISEASE; Radical cystectomy; Bladder cancer; Urothelial carcinoma; Lymph node; Lymphovascular invasion; Prognosis; Survival; Adjuvant chemotherapy |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Urologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 27 Apr 2020 07:47 |
| Last Modified: | 27 Apr 2020 07:47 |
| URI: | https://pred.uni-regensburg.de/id/eprint/17250 |
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