title: Lymph node metastases in non-muscle invasive bladder cancer are correlated with the number of transurethral resections and tumour upstaging at radical cystectomy.
abstract: The first paper in this section, from Mainz, attempts to identify the clinical variables associated with the prevalence of lymph node metastases in non-muscle invasive bladder cancer. The authors found that delay in cystectomy in this potentially dangerous type of tumour is to be avoided, with a higher incidence of lymph node metastases as the number of transurethral resections increases. A paper from Austria shows that in renal carcinoma the pT1 subdivision is associated with differences in conventional histopathology and expression of biomarkers.
  
  
  OBJECTIVE
  To identify clinical variables associated with the prevalence of lymph node metastases (LNMs) in patients with non-muscle invasive transitional cell carcinoma (TCC) of the bladder treated with radical cystectomy.
  
  
  METHODS
  Of 866 patients treated by radical cystectomy and pelvic lymphadenectomy between 1989 and 2002, 219 had non-muscle invasive TCC of the bladder. A retrospective evaluation of these patients included univariate and multivariate analyses of sex, age, number of transurethral resections of the bladder tumour (TURBTs), interval between first TURBT and cystectomy, adjuvant therapy, maximum histopathological tumour stage and grade at TURBT, and tumour upstaging in the cystectomy specimen.
  
  
  RESULTS
  LNMs were diagnosed in 33 patients (15%). After multivariate analysis modelling, the number of TURBTs and tumour upstaging in the cystectomy specimen were correlated with the prevalence of LNMs at cystectomy. The number of TURBTs increased the prevalence of LNMs from 8% in patients with one TURBT to 24% in those with two to four TURBTs. Tumour upstaging in the cystectomy specimen increased the prevalence of LNMs from 4% to 36%.
  
  
  CONCLUSIONS
  Inappropriate delay and inadequate staging of high-grade non-muscle invasive TCC of the bladder are to be avoided. The present multivariate analysis showed that the number of TURBTs and tumour upstaging in the cystectomy specimen correlated with an increased prevalence of LNMs.
authors.affiliation: Department of Urology, Medical School Johannes Gutenburg-University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany. ChristophWs@AOL.com
authors.forename: Christoph
authors.initials: C
authors.lastname: Wiesner
authors.forename: Jesco
authors.initials: J
authors.lastname: Pfitzenmaier
authors.forename: Andreas
authors.initials: A
authors.lastname: Faldum
authors.forename: Rolf
authors.initials: R
authors.lastname: Gillitzer
authors.forename: Sebastian W
authors.initials: SW
authors.lastname: Melchior
authors.forename: Joachim W
authors.initials: JW
authors.lastname: Thüroff
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000556:secondary* / Q000601:surgery; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D012086:Reoperation; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery