TY - JOUR
T1 - Critical analysis and validation of lymph node density as prognostic variable in urothelial carcinoma of bladder
AU - Kassouf, Wassim
AU - Svatek, Robert S.
AU - Shariat, Shahrokh F.
AU - Novara, Giacomo
AU - Lerner, Seth P.
AU - Fradet, Yves
AU - Bastian, Patrick J.
AU - Aprikian, Armen
AU - Karakiewicz, Pierre I.
AU - Fritsche, Hans Martin
AU - Dinney, Colin P.N.
AU - Tilki, Derya
AU - Kamat, Ashish M.
AU - Izawa, Jonathan I.
AU - Ficarra, Vincenzo
AU - Lotan, Yair
AU - Sagalowsky, Arthur I.
AU - Schoenberg, Mark P.
AU - Skinner, Eila C.
PY - 2013/5
Y1 - 2013/5
N2 - 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.
AB - 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.
UR - https://www.scopus.com/pages/publications/84876723136
UR - https://www.scopus.com/pages/publications/84876723136#tab=citedBy
U2 - 10.1016/j.urolonc.2011.02.011
DO - 10.1016/j.urolonc.2011.02.011
M3 - Article
C2 - 21478035
AN - SCOPUS:84876723136
SN - 1078-1439
VL - 31
SP - 480
EP - 486
JO - Urologic Oncology: Seminars and Original Investigations
JF - Urologic Oncology: Seminars and Original Investigations
IS - 4
ER -