title: The prognostic impact of pelvic lymph node metastasis and lymphovascular invasion on bladder cancer.
abstract: OBJECTIVE
  To present long-term results of a single-center series of patients undergoing bilateral pelvic lymphadenectomy and radical cystectomy for bladder cancer and to analyze the impact of pelvic lymph node metastasis and lymphovascular invasion on clinical outcome.
  
  
  METHODS
  Between 1986 and 2005 833 patients were treated with bilateral pelvic lymphadenectomy and radical cystectomy at our institution. 614 of them with valid clinical follow-up information and no neoadjuvant therapy could be evaluated.
  
  
  RESULTS
  Disease-free and overall survival in the entire cohort was 56.7% and 49.5% at 5 years and 52.4% and 38.2% at 10 years, respectively. 28.1% of all patients had pelvic lymph node metastasis. We found organ-confined tumor stages (<or=pT2) in 43.8%. Patients with non-organ-confined tumor stages (>or=pT3) and positive pelvic lymph nodes had a significantly shorter overall survival than those without lymph node metastasis (P < 0.0001). In the subgroup of <or=pT2, the presence of pelvic lymph node metastasis did not show a statistically significant effect on overall survival (P = 0.618). The presence of lymphovascular invasion was associated with an impaired survival (P < 0.0001). In multivariate analysis, pathological tumor stage (P < 0.0001), lymph node stage (>or=pT3) (P = 0.004) and lymphovascular invasion (P = 0.001) were independent prognostic parameters.
  
  
  CONCLUSIONS
  According to the present series, survival for patients with <or=pT2 does not depend on the lymph node stage. Lymphovascular invasion is an independent parameter of impaired survival and should be determined routinely in cystectomy specimens to identify patients, who may benefit from adjuvant systemic therapy.
authors.affiliation: Department of Urology, University of Münster, Münster, Germany. herrmae@ukmuenster.de
authors.forename: Edwin
authors.initials: E
authors.lastname: Herrmann
authors.forename: Eva
authors.initials: E
authors.lastname: Stöter
authors.forename: Arndt
authors.initials: A
authors.lastname: van Ophoven
authors.forename: Stefan
authors.initials: S
authors.lastname: Bierer
authors.forename: Christian
authors.initials: C
authors.lastname: Bolenz
authors.forename: Lothar
authors.initials: L
authors.lastname: Hertle
authors.forename: Christian
authors.initials: C
authors.lastname: Wülfing
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010388:Pelvis; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D019043:Vascular Neoplasms / Q000473:pathology*