title: Lymph node density is superior to TNM nodal status in predicting disease-specific survival after radical cystectomy for bladder cancer: analysis of pooled data from MDACC and MSKCC.
abstract: OBJECTIVE
  To compare the utility of lymph node density (LND) with TNM nodal status in predicting disease-specific survival (DSS) after radical cystectomy.
  
  
  METHODS
  We identified 248 patients with nodal metastasis after radical cystectomy (without neoadjuvant chemotherapy): 162 patients from Memorial Sloan-Kettering Cancer Center (MSKCC) and 86 patients from M.D. Anderson Cancer Center (MDACC). We assessed the effect of several variables on DSS.
  
  
  RESULTS
  After a median follow-up duration of 24 months, 134 patients died of their disease. The median DSS was 36 months, and the 1-year, 2-year, and 5-year DSS rates were 83.7%, 57.4%, and 36.6%, respectively. The median LND was 20%. The 5-year DSS rate was 54.6% for patients with LND < or = 20% v 15.3% for patients with LND higher than 20% (P < .01). Pathologic nodal (pN) status in patients was 78 for pN1 (32%), 127 for pN2 (51%), and 43 for pN3 (17%). On univariate analysis, pN status and LND were significant predictors of DSS (P < .01). However, when pN status and LND were considered jointly in a multivariate model, only LND higher than 20% predicted decreased DSS (hazard ratio [HR], 2.75; P < .01). In addition, while nonorgan-confined (ie, > pT2) primary tumor (HR, 2.40; P < .01) and adjuvant chemotherapy (HR, 0.47; P < .01) were predictors of DSS, LND remained a predictor of DSS even after accounting for adjuvant chemotherapy.
  
  
  CONCLUSIONS
  LND is superior to TNM nodal status in predicting DSS for patients with lymph node-positive disease after radical cystectomy, even in the context of adjuvant chemotherapy.
authors.affiliation: Department of Urology and the Division of Quantitative Sciences, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
authors.forename: Piyush K
authors.initials: PK
authors.lastname: Agarwal
authors.forename: Harry W
authors.initials: HW
authors.lastname: Herr
authors.forename: Mark F
authors.initials: MF
authors.lastname: Munsell
authors.forename: Philippe E
authors.initials: PE
authors.lastname: Spiess
authors.forename: Gordon A
authors.initials: GA
authors.lastname: Brown
authors.forename: Louis
authors.initials: L
authors.lastname: Pisters
authors.forename: H Barton
authors.initials: HB
authors.lastname: Grossman
authors.forename: Colin P
authors.initials: CP
authors.lastname: Dinney
authors.forename: Ashish M
authors.initials: AM
authors.lastname: Kamat
mesh_terms: D017024:Chemotherapy, Adjuvant; D015653:Cystectomy; D018572:Disease-Free Survival; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000601:surgery*