title: Association of intravesical tumor location with metastases to the pelvic lymph nodes in transitional cell cancer of the bladder.
abstract: BACKGROUND
  In this study, we aimed to determine those clinical and pathologic features that are associated with pelvic lymph node metastasis in patients with transitional cell cancer of the bladder. Unlike previous studies, we particularly focused on intravesical tumor location.
  
  
  METHODS
  We included 173 patients who underwent radical cystectomy and bilateral pelvic lymphadenectomy for muscle-invasive or high-risk superficial bladder cancer. Fifty patients (28.9%) presented with lymph node metastases. Tumor-related and personal characteristics were analyzed.
  
  
  RESULTS
  Lymph node positive disease occurred in association with an increasing pathologic tumor stage (P < 10(-6)) and with a decreasing differentiation status (P = 0.008). The rate of pelvic lymph node metastasis differed in primary tumors growing on different intravesical locations. Cancers located exclusively on the lateral bladder walls (P < 10(-5)) and tumors involving the lateral walls (P = 0.042) were highly correlated with lymph node positive disease. Posterior wall tumors were least associated with lymph node metastases compared with other tumor locations (P = 0.015). Focal tumor growths located on the lateral bladder wall and an increasing pathologic tumor stage and decreasing differentiation-status were identified as independent risk factors for the pelvic lymph node status.
  
  
  CONCLUSIONS
  For the first time we present the association of intravesical tumor location and the rate of lymph node metastasis in transitional cell cancer of the bladder. Our findings may ultimately contribute to a more individualized patient management.
authors.affiliation: Department of Urology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany. steffen.wedel@gmx.de
authors.forename: Steffen Alexander
authors.initials: SA
authors.lastname: Wedel
authors.forename: Jon
authors.initials: J
authors.lastname: Jones
authors.forename: Igor
authors.initials: I
authors.lastname: Tsaur
authors.forename: Hanns
authors.initials: H
authors.lastname: Ackermann
authors.forename: Wolf-Dietrich
authors.initials: WD
authors.lastname: Beecken
authors.forename: Dietger
authors.initials: D
authors.lastname: Jonas
authors.forename: Roman
authors.initials: R
authors.lastname: Blaheta
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000473:pathology* / Q000556:secondary* / Q000628:therapy; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D010386:Pelvic Neoplasms / Q000473:pathology* / Q000556:secondary* / Q000628:therapy; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000628:therapy