title: Role of lymph node density in predicting survival of patients with lymph node metastases after radical cystectomy: a multi-institutional study.
abstract: OBJECTIVE
  To evaluate the prognostic role of different clinico-pathological parameters in node-positive patients treated by radical cystectomy.
  
  
  METHODS
  A retrospective multi-institutional study of 435 patients who underwent radical cystectomy between 1990 and 2005 was carried out. Of them, pathological lymph node (LN) metastases were found in 83 patients. Sixty of these 83 patients, whose clinical information and follow-up data were available, were included in the analysis. Twenty-five patients had undergone adjuvant chemotherapy, whereas 35 had not. A Cox proportional hazards model was used to determine the impact of the following clinico-pathological parameters on patient survival: number of resected LNs, number of positive LNs, LN density (defined as the ratio of the number of positive LNs divided by the total number of resected LNs) and adjuvant chemotherapy.
  
  
  RESULTS
  Median follow-up for surviving patients was 41 months (range 4-138) after surgery. The median survival time for all patients was 22 months (95% confidence interval, 15-42 months). At multivariate analysis, LN density of 25% or less, adjuvant chemotherapy and pure urothelial carcinoma were independently significant predictors of survival.
  
  
  CONCLUSIONS
  Lymph node density predicts survival in patients with node-positive bladder cancer.
authors.affiliation: Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Osawa
authors.forename: Takashige
authors.initials: T
authors.lastname: Abe
authors.forename: Nobuo
authors.initials: N
authors.lastname: Shinohara
authors.forename: Toru
authors.initials: T
authors.lastname: Harabayashi
authors.forename: Ataru
authors.initials: A
authors.lastname: Sazawa
authors.forename: Kanako
authors.initials: K
authors.lastname: Kubota
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Matsuno
authors.forename: Takeshi
authors.initials: T
authors.lastname: Shibata
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Shinno
authors.forename: Shinji
authors.initials: S
authors.lastname: Kamota
authors.forename: Keita
authors.initials: K
authors.lastname: Minami
authors.forename: Shigeo
authors.initials: S
authors.lastname: Sakashita
authors.forename: Akira
authors.initials: A
authors.lastname: Kumagai
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Mori
authors.forename: Katsuya
authors.initials: K
authors.lastname: Nonomura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000401:mortality* / Q000556:secondary / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007564:Japan; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*