title: Clinical outcomes and recurrence predictors of lymph node positive urothelial cancer after cystectomy.
abstract: OBJECTIVE
  Lymph node metastasis in patients who undergo radical cystectomy for bladder transitional cell carcinoma is considered a poor prognostic factor. However, patients with minimal lymph node involvement likely have a better outcome than those with extensive disease. We examined outcomes in patients with low volume lymph node metastasis and identified variables associated with disease recurrence.
  
  
  METHODS
  Our institution maintains a database of 1,600 patients with bladder transitional carcinoma who underwent radical cystectomy from 1971 to 2005 with intent to cure. All patients with low volume lymph node metastasis, defined as 1 or 2 positive lymph nodes, without concomitant distant metastasis were included in study.
  
  
  RESULTS
  A total of 181 patients were identified. Median followup was 12.8 years, during which 96 patients experienced recurrence. Estimated 5 and 10-year recurrence-free survival was 43.8% and 40.9%, respectively. Multivariate analysis indicated that pathological stage/subgroup (RR 1.733, p = 0.015), lymph node density (RR 1.935, p = 0.014) and adjuvant chemotherapy (RR 0.538, p = 0.004) were significant independent predictors of recurrence-free survival.
  
  
  CONCLUSIONS
  A considerable proportion of patients with low volume lymph node metastasis in our cohort remained free of recurrence during followup. Extravesical tumor extension and lymph node density greater than 4% were associated with a higher recurrence risk and adjuvant chemotherapy was associated with a lower risk. Although some patients with low volume lymph node metastasis may be cured by surgery alone, these data support adjuvant chemotherapy in these patients.
authors.affiliation: Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
authors.forename: Harman M
authors.initials: HM
authors.lastname: Bruins
authors.forename: George J
authors.initials: GJ
authors.lastname: Huang
authors.forename: Jie
authors.initials: J
authors.lastname: Cai
authors.forename: Donald G
authors.initials: DG
authors.lastname: Skinner
authors.forename: John P
authors.initials: JP
authors.lastname: Stein
authors.forename: David F
authors.initials: DF
authors.lastname: Penson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000453:epidemiology / Q000556:secondary* / Q000601:surgery; D015653:Cystectomy; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D011379:Prognosis; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology* / Q000473:pathology* / Q000601:surgery