Role of lymph node density in predicting survival of patients with lymph node metastases after radical cystectomy: a multi-institutional study.
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.
Osawa
Takahiro
T
Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
Abe
Takashige
T
Shinohara
Nobuo
N
Harabayashi
Toru
T
Sazawa
Ataru
A
Kubota
Kanako
K
Matsuno
Yoshihiro
Y
Shibata
Takeshi
T
Shinno
Yuichiro
Y
Kamota
Shinji
S
Minami
Keita
K
Sakashita
Shigeo
S
Kumagai
Akira
A
Mori
Tatsuya
T
Nonomura
Katsuya
K
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*