Transitional cell carcinoma of the urinary bladder with regional lymph node involvement treated by cystectomy: clinicopathologic features associated with outcome.
BACKGROUND
Patients with transitional cell carcinoma (TCC) of the urinary bladder metastatic to regional lymph nodes (LN) typically have a poor prognosis. However, some patients are cured by radical cystectomy alone. The goal of this study was to identify predictors of survival in this cohort.


METHODS
The authors identified 154 patients with TCC metastatic to regional LNs treated by cystectomy between 1970 and 1998. Clinical characteristics collected included age, gender, and preoperative computed tomographic or magnetic resonance image scan findings, as well as neoadjuvant and adjuvant therapy. Pathologic features evaluated included multifocality, size, pathologic stage, grade, and margin status of the primary tumor, as well as the number, location, and bilaterality of the positive LNs. Capsular penetration, greatest linear extent, and surface area of the largest metastatic LN deposit were also recorded. The Kaplan-Meier method was used to evaluate survival rates. Cox proportional hazards models were used to identify predictors of outcome.


RESULTS
The mean follow-up was 4.5 years (range, 0.1-13.9 years). In a multivariate setting, only adjuvant chemotherapy and the number of positive LNs were associated significantly with death from TCC. Patients treated adjuvantly with chemotherapy were 2.1 times less likely to die of their disease (P = 0.005). Each increase in one positive LN increased the risk of death from TCC by 20% (P < 0.001). Recursive partitioning indicated that the optimal cutoff point to predict death from TCC was five or more positive LNs.


CONCLUSIONS
Adjuvant chemotherapy and the number of positive LNs were associated significantly with death from TCC.
Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA. frank.igor@mayo.edu
Igor
I
Frank
John C
JC
Cheville
Michael L
ML
Blute
Christine M
CM
Lohse
Ajay
A
Nehra
Amy L
AL
Weaver
R Jeffrey
RJ
Karnes
Horst
H
Zincke
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality* / Q000556:secondary / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D003131:Combined Modality Therapy; D015653:Cystectomy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D009367:Neoplasm Staging / Q000379:methods; D016016:Proportional Hazards Models; D012307:Risk Factors; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D001749:Urinary Bladder Neoplasms / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality* / Q000473:pathology / Q000628:therapy