Does increasing the nodal yield improve outcomes in patients without nodal metastasis at radical cystectomy?

Michael Rink, Shahrokh F. Shariat, Evanguelos Xylinas, John P. Fitzgerald, Jens Hansen, David A. Green, Ashish M. Kamat, Giacomo Novara, Siamak Daneshmand, Yves Fradet, Scott T. Tagawa, Patrick J. Bastian, Wassim Kassouf, Quoc Dien Trinh, Pierre I. Karakiewicz, Hans Martin Fritsche, Derya Tilki, Felix K. Chun, Bjoern G. Volkmer, Marko BabjukAxel S. Merseburger, Douglas S. Scherr, Yair Lotan, Robert Svatek

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Purpose: To determine whether the number of lymph nodes (LNs) examined is associated with outcomes in patients without nodal metastasis after radical cystectomy (RC). Patients and Methods: 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 ≥9 and ≥20. Results: The median nodal yield was 18 (range 1-123; IQR:20). A total of 2591 (84 %) and 1445 (47 %) patients had a LN yield ≥9 and ≥20, 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 ≥20: HR = 0.851, p = 0.032). In the subgroups of patients with muscle-invasive UCB or those with ≥9 LN removed, LN yield was not associated with outcomes (p values >0.05). Conclusions: 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 (≥20 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.

Original languageEnglish (US)
Pages (from-to)807-814
Number of pages8
JournalWorld Journal of Urology
Volume30
Issue number6
DOIs
StatePublished - Dec 2012

Fingerprint

Cystectomy
Lymph Nodes
Neoplasm Metastasis
Urinary Bladder
Carcinoma
Recurrence
Muscles
Adjuvant Chemotherapy
Lymph Node Excision
Prospective Studies

Keywords

  • Bladder cancer
  • Lymph node
  • Radical cystectomy
  • Recurrence
  • Survival
  • Transitional cell carcinoma

ASJC Scopus subject areas

  • Urology

Cite this

Does increasing the nodal yield improve outcomes in patients without nodal metastasis at radical cystectomy? / Rink, Michael; Shariat, Shahrokh F.; Xylinas, Evanguelos; Fitzgerald, John P.; Hansen, Jens; Green, David A.; Kamat, Ashish M.; Novara, Giacomo; Daneshmand, Siamak; Fradet, Yves; Tagawa, Scott T.; Bastian, Patrick J.; Kassouf, Wassim; Trinh, Quoc Dien; Karakiewicz, Pierre I.; Fritsche, Hans Martin; Tilki, Derya; Chun, Felix K.; Volkmer, Bjoern G.; Babjuk, Marko; Merseburger, Axel S.; Scherr, Douglas S.; Lotan, Yair; Svatek, Robert.

In: World Journal of Urology, Vol. 30, No. 6, 12.2012, p. 807-814.

Research output: Contribution to journalArticle

Rink, M, Shariat, SF, Xylinas, E, Fitzgerald, JP, Hansen, J, Green, DA, Kamat, AM, Novara, G, Daneshmand, S, Fradet, Y, Tagawa, ST, Bastian, PJ, Kassouf, W, Trinh, QD, Karakiewicz, PI, Fritsche, HM, Tilki, D, Chun, FK, Volkmer, BG, Babjuk, M, Merseburger, AS, Scherr, DS, Lotan, Y & Svatek, R 2012, 'Does increasing the nodal yield improve outcomes in patients without nodal metastasis at radical cystectomy?', World Journal of Urology, vol. 30, no. 6, pp. 807-814. https://doi.org/10.1007/s00345-012-0910-5
Rink, Michael ; Shariat, Shahrokh F. ; Xylinas, Evanguelos ; Fitzgerald, John P. ; Hansen, Jens ; Green, David A. ; Kamat, Ashish M. ; Novara, Giacomo ; Daneshmand, Siamak ; Fradet, Yves ; Tagawa, Scott T. ; Bastian, Patrick J. ; Kassouf, Wassim ; Trinh, Quoc Dien ; Karakiewicz, Pierre I. ; Fritsche, Hans Martin ; Tilki, Derya ; Chun, Felix K. ; Volkmer, Bjoern G. ; Babjuk, Marko ; Merseburger, Axel S. ; Scherr, Douglas S. ; Lotan, Yair ; Svatek, Robert. / Does increasing the nodal yield improve outcomes in patients without nodal metastasis at radical cystectomy?. In: World Journal of Urology. 2012 ; Vol. 30, No. 6. pp. 807-814.
@article{060a54640e7e4ce8b2d0d20ea7db140c,
title = "Does increasing the nodal yield improve outcomes in patients without nodal metastasis at radical cystectomy?",
abstract = "Purpose: To determine whether the number of lymph nodes (LNs) examined is associated with outcomes in patients without nodal metastasis after radical cystectomy (RC). Patients and Methods: 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 ≥9 and ≥20. Results: The median nodal yield was 18 (range 1-123; IQR:20). A total of 2591 (84 {\%}) and 1445 (47 {\%}) patients had a LN yield ≥9 and ≥20, 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 ≥20: HR = 0.851, p = 0.032). In the subgroups of patients with muscle-invasive UCB or those with ≥9 LN removed, LN yield was not associated with outcomes (p values >0.05). Conclusions: 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 (≥20 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.",
keywords = "Bladder cancer, Lymph node, Radical cystectomy, Recurrence, Survival, Transitional cell carcinoma",
author = "Michael Rink and Shariat, {Shahrokh F.} and Evanguelos Xylinas and Fitzgerald, {John P.} and Jens Hansen and Green, {David A.} and Kamat, {Ashish M.} and Giacomo Novara and Siamak Daneshmand and Yves Fradet and Tagawa, {Scott T.} and Bastian, {Patrick J.} and Wassim Kassouf and Trinh, {Quoc Dien} and Karakiewicz, {Pierre I.} and Fritsche, {Hans Martin} and Derya Tilki and Chun, {Felix K.} and Volkmer, {Bjoern G.} and Marko Babjuk and Merseburger, {Axel S.} and Scherr, {Douglas S.} and Yair Lotan and Robert Svatek",
year = "2012",
month = "12",
doi = "10.1007/s00345-012-0910-5",
language = "English (US)",
volume = "30",
pages = "807--814",
journal = "World Journal of Urology",
issn = "0724-4983",
publisher = "Springer Verlag",
number = "6",

}

TY - JOUR

T1 - Does increasing the nodal yield improve outcomes in patients without nodal metastasis at radical cystectomy?

AU - Rink, Michael

AU - Shariat, Shahrokh F.

AU - Xylinas, Evanguelos

AU - Fitzgerald, John P.

AU - Hansen, Jens

AU - Green, David A.

AU - Kamat, Ashish M.

AU - Novara, Giacomo

AU - Daneshmand, Siamak

AU - Fradet, Yves

AU - Tagawa, Scott T.

AU - Bastian, Patrick J.

AU - Kassouf, Wassim

AU - Trinh, Quoc Dien

AU - Karakiewicz, Pierre I.

AU - Fritsche, Hans Martin

AU - Tilki, Derya

AU - Chun, Felix K.

AU - Volkmer, Bjoern G.

AU - Babjuk, Marko

AU - Merseburger, Axel S.

AU - Scherr, Douglas S.

AU - Lotan, Yair

AU - Svatek, Robert

PY - 2012/12

Y1 - 2012/12

N2 - Purpose: To determine whether the number of lymph nodes (LNs) examined is associated with outcomes in patients without nodal metastasis after radical cystectomy (RC). Patients and Methods: 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 ≥9 and ≥20. Results: The median nodal yield was 18 (range 1-123; IQR:20). A total of 2591 (84 %) and 1445 (47 %) patients had a LN yield ≥9 and ≥20, 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 ≥20: HR = 0.851, p = 0.032). In the subgroups of patients with muscle-invasive UCB or those with ≥9 LN removed, LN yield was not associated with outcomes (p values >0.05). Conclusions: 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 (≥20 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.

AB - Purpose: To determine whether the number of lymph nodes (LNs) examined is associated with outcomes in patients without nodal metastasis after radical cystectomy (RC). Patients and Methods: 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 ≥9 and ≥20. Results: The median nodal yield was 18 (range 1-123; IQR:20). A total of 2591 (84 %) and 1445 (47 %) patients had a LN yield ≥9 and ≥20, 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 ≥20: HR = 0.851, p = 0.032). In the subgroups of patients with muscle-invasive UCB or those with ≥9 LN removed, LN yield was not associated with outcomes (p values >0.05). Conclusions: 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 (≥20 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.

KW - Bladder cancer

KW - Lymph node

KW - Radical cystectomy

KW - Recurrence

KW - Survival

KW - Transitional cell carcinoma

UR - http://www.scopus.com/inward/record.url?scp=84870363140&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84870363140&partnerID=8YFLogxK

U2 - 10.1007/s00345-012-0910-5

DO - 10.1007/s00345-012-0910-5

M3 - Article

C2 - 22832587

AN - SCOPUS:84870363140

VL - 30

SP - 807

EP - 814

JO - World Journal of Urology

JF - World Journal of Urology

SN - 0724-4983

IS - 6

ER -