The role of pelvic lymphadenectomy and radical cystectomy for lymph node positive bladder cancer. The Memorial Sloan-Kettering Cancer Center experience.
BACKGROUND
The impact of pelvic lymph node dissection (PLND) on the survival of patients with lymph node positive bladder cancer is controversial.


METHODS
The authors retrospectively analyzed the long term and disease free survival among 140 patients with lymph node positive disease having radical cystectomy and bilateral PLND at the Memorial Sloan-Kettering Cancer Center between 1980 and 1988. They also sought to identify prognostic variables for recurrence and survival.


RESULTS
Of the 140 patients, 36 (25.7%) were found to be tumor free, with 22 (15.7%) followed longer than 5 years. Regression analysis identified P-category as the only prognostic parameter influencing survival. Patients with tumors confined to the bladder (< or = P3a) had a 52.6% 5-year survival rate compared with 23.4% among those with extravesical (> or = P3b) tumors. N-category was a significant predictor for recurrence but not survival.


CONCLUSIONS
As judged from this analysis, radical cystectomy and a systematic PLND alone can provide favorable outcome in some patients with regional nodal metastases from bladder cancer. The survival advantage is most pronounced in patients with low stage primary tumors. Stage migration and patient selection may have biased these findings.
Vieweg
J
J
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021.
Whitmore
W F
WF
Herr
H W
HW
Sogani
P C
PC
Russo
P
P
Sheinfeld
J
J
Fair
W R
WR
D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D010388:Pelvis; D011379:Prognosis; D012044:Regression Analysis; D015996:Survival Rate; D001743:Urinary Bladder / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*