The concept of lymph node density--is it ready for clinical practice?
OBJECTIVE
The concept of lymph node density (ratio of positive-to-total number of nodes examined) is reviewed as a prognostic factor for recurrence-free survival after cystectomy in patients with invasive bladder cancer.


METHODS
The literature was queried for all articles that directly or indirectly address lymph node density (nodal ratios) and survival of bladder cancer.


RESULTS
Five studies on a total of 979 patients were found. In 4 studies lymph node density was a significant predictive factor for survival when adjusted for patient, tumor and treatment covariates.


CONCLUSIONS
Considerable data support the use of lymph node density in bladder cancer prognosis. A methodological evaluation of the prognostic importance of nodal ratios in large multicenter data sets and validation in a prospective clinical trial are merited before lymph node density is accepted into routine clinical practice.
Herr
Harry W
HW
Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA. herrh@mskcc.org
D015653:Cystectomy; D018572:Disease-Free Survival; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D011379:Prognosis; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery