Rink, Michael and Shariat, Shahrokh F. and Xylinas, Evanguelos and Fitzgerald, John P. and Hansen, Jens and Green, David A. and Kamat, Ashish M. and Novara, Giacomo and Daneshmand, Siamak and Fradet, Yves and Tagawa, Scott T. and Bastian, Patrick J. and Kassouf, Wassim and Quoc-Dien Trinh, and Karakiewicz, Pierre I. and Fritsche, Hans-Martin and Tilki, Derya and Chun, Felix K. and Volkmer, Bjoern G. and Babjuk, Marko and Merseburger, Axel S. and Scherr, Douglas S. and Lotan, Yair and Svatek, Robert S. (2012) Does increasing the nodal yield improve outcomes in patients without nodal metastasis at radical cystectomy? WORLD JOURNAL OF UROLOGY, 30 (6). pp. 807-814. ISSN 0724-4983,
Full text not available from this repository. (Request a copy)Abstract
To determine whether the number of lymph nodes (LNs) examined is associated with outcomes in patients without nodal metastasis after radical cystectomy (RC). We retrospectively analyzed data from 4,188 patients treated at 12 centers with RC and pelvic lymphadenectomy without neo-adjuvant chemotherapy for urothelial carcinoma of the bladder (UCB). Outcomes of patients without LN metastasis (n = 3,088) were examined according to the LN yield analyzed as continuous variable, tertiles, and using the cutoffs of a parts per thousand yen9 and a parts per thousand yen20. The median nodal yield was 18 (range 1-123; IQR:20). A total of 2591 (84 %) and 1445 (47 %) patients had a LN yield a parts per thousand yen9 and a parts per thousand yen20, respectively. Median follow-up was 47 months (IQR:70). In multivariable analyses that adjusted for the standard clinicopathologic factors, higher LN yield was associated with a decreased risk of disease recurrence (continuous: HR = 0.996, p = 0.05; 3rd vs 1st tertile: HR = 0.853, p = 0.048; cutoff a parts per thousand yen20: HR = 0.851, p = 0.032). In the subgroups of patients with muscle-invasive UCB or those with a parts per thousand yen9 LN removed, LN yield was not associated with outcomes (p values > 0.05). In this large multicenter cohort of patients with node-negative UCB, higher nodal yield improved recurrence-free survival when all patients were analyzed. Patients with a high LN yield (a parts per thousand yen20 LN removed or 3rd tertile) had the largest benefit. The lack of prognostic significance of LN yield in patients with muscle-invasive UCB or those stratified by 9 LNs removed suggests that this effect is weak. Further prospective studies are needed to help identify preoperatively the optimal template for each patient.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | INVASIVE BLADDER-CANCER; TRANSITIONAL-CELL CARCINOMA; LYMPH-NODES; PELVIC LYMPHADENECTOMY; PROSTATE-CANCER; DISSECTION; STANDARDIZATION; PROGNOSIS; SURVIVAL; NUMBER; Bladder cancer; Survival; Recurrence; Radical cystectomy; Lymph node; Transitional cell carcinoma |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Urologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 04 May 2020 05:50 |
| Last Modified: | 04 May 2020 05:50 |
| URI: | https://pred.uni-regensburg.de/id/eprint/17690 |
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