title: Relevance of extracapsular extension of pelvic lymph node metastasis in patients with bladder cancer treated in the contemporary era.
abstract: BACKGROUND
  Previous reports have suggested that extracapsular extension (ECE) is a prognostic factor in patients with urothelial carcinoma who have positive lymph nodes at the time of radical cystectomy. In the current study, the relevance of ECE in patients treated in the contemporary era was evaluated.
  
  
  METHODS
  A database search from 1993 to 2003 revealed 150 patients with pN+M0 disease detected after radical cystectomy; of these, 108 patients did not receive neoadjuvant chemotherapy and form the basis of the current report. Overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) data were analyzed by the Kaplan-Meier method, with log-rank tests used to evaluate associations between survival and variables studied.
  
  
  RESULTS
  Five-year OS, DSS, and RFS rates were 30.9%, 45.5%, and 29.7%, respectively. Adjuvant chemotherapy was administered to 70% of patients. On multivariate analysis, adjuvant chemotherapy was significantly associated with prolonged OS, DSS, and RFS (P </= .01). For patients overall and when stratified by pN status, the presence of ECE of lymph node metastasis was not found to be significantly associated with OS (P = .52), DSS (P = .43), or RFS (P = .83). CONCLUSIONS.: The current study suggests that ECE is not an independent prognostic factor in a contemporary series of patients with positive lymph nodes at radical cystectomy. This might be reflective of a paradigm shift that encompasses the adoption of multimodal therapy.
authors.affiliation: Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
authors.forename: Dan
authors.initials: D
authors.lastname: Leibovici
authors.forename: Tony
authors.initials: T
authors.lastname: Luongo
authors.forename: Mark F
authors.initials: MF
authors.lastname: Munsell
authors.forename: Funda
authors.initials: F
authors.lastname: Vakar
authors.forename: Colin P
authors.initials: CP
authors.lastname: Dinney
authors.forename: H Barton
authors.initials: HB
authors.lastname: Grossman
authors.forename: Ashish M
authors.initials: AM
authors.lastname: Kamat
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D015653:Cystectomy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D010388:Pelvis; D011379:Prognosis; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy