The prognostic impact of pelvic lymph node metastasis and lymphovascular invasion on bladder cancer.
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.
Herrmann
Edwin
E
Department of Urology, University of Münster, Münster, Germany. herrmae@ukmuenster.de
Stöter
Eva
E
van Ophoven
Arndt
A
Bierer
Stefan
S
Bolenz
Christian
C
Hertle
Lothar
L
Wülfing
Christian
C
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*