May, Matthias and Herrmann, Edwin and Bolenz, Christian and Tiemann, Arne and Brookman-May, Sabine and Fritsche, Hans-Martin and Burger, Maximilian and Buchner, Alexander and Gratzke, Christian and Wuelfing, Christian and Trojan, Lutz and Ellinger, Joerg and Tilki, Derya and Gilfrich, Christian and Hoefner, Thomas and Roigas, Jan and Zacharias, Mario and Gunia, Sven and Wieland, Wolf F. and Hohenfellner, Markus and Michel, Maurice S. and Haferkamp, Axel and Mueller, Stefan C. and Stief, Christian G. and Bastian, Patrick J. (2011) Lymph Node Density Affects Cancer-Specific Survival in Patients with Lymph Node-Positive Urothelial Bladder Cancer Following Radical Cystectomy. EUROPEAN UROLOGY, 59 (5). pp. 712-718. ISSN 0302-2838,
Full text not available from this repository. (Request a copy)Abstract
Background: The prognosis for patients with lymph node (LN)-positive bladder cancer (BCa) is likely affected by the extent of lymphadenectomy in radical cystectomy (RC) cases. Specifically, the prognostic significance of the LN density (ratio of positive LNs to the total number removed) has been demonstrated. Objective: To evaluate the prognostic signature of lymphadenectomy variables, including the LN density, for a large, multicentre cohort of RC patients with LN-positive BCa. Design, setting, and participants: The clinical and histopathologic data from 477 patients with LN-positive urothelial BCa (pN1-2) were analysed. The median follow-up period for all living patients was 28 mo. Measurements: Multivariable Cox regression analysis was used to test the effect of various pelvic lymph node dissection (PLND) variables on cancer-specific survival (CSS) based on colinearity in various models. Results and limitations: The median number of LNs removed was 12 (range: 1- 66), and the median number of positive LNs was 2 (range: 1-25). Two hundred ninety (60.8%) of the patients presented with stage pN2 disease. The median and mean LN density was 17.6% and 29% (range: 2.3-100), respectively, where 268 (56.2%) and 209 (43.8%) patients exhibited am LN density of <= 20% and > 20%, respectively. In separate multivariable Cox regression models adjusted for age, sex, pTN stage, grade, associated Tis, and adjuvant chemotherapy, the interval-scaled LN density (hazard ratio [HR]: 1.01; p = 0.002) and the LN density, ordinal-scaled by 20% (HR: 1.65; p < 0.001) exhibit independent effects on CSS. In addition, an independent contribution appears from the pT but not the pN stage. Limitations include surgeon selection bias when determining the extent of lymphadenectomy. Conclusions: Our results support the prognostic relevance of LN density in patients with LN-positive BCa, where a threshold value of 20% stratifies the population into two prognostically distinct groups. Before LN density is integrated into the clinical decision-making process, these results should be validated by prospective studies with defined LN templates and standardised histopathologic methods. # 2011 European Association of Urology. Published by Elsevier B. V. All rights reserved.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | PELVIC LYMPHADENECTOMY; METASTASES; EXTENT; Bladder cancer; Urothelial cancer; Radical cystectomy; Lymphadenectomy; Lymph node metastases; Number of lymph nodes; Lymph node density; Prognosis |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Urologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 22 Jun 2020 07:09 |
| Last Modified: | 22 Jun 2020 07:09 |
| URI: | https://pred.uni-regensburg.de/id/eprint/20919 |
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