title: Extracapsular extension but not the tumour burden of lymph node metastases is an independent adverse risk factor in lymph node-positive bladder cancer.
abstract: OBJECTIVE
  To evaluate risk factors in lymph node-positive bladder cancer.
  
  
  RESULTS
  Lymph node-positive bladder cancer patients (n=162), preoperatively staged N0M0, underwent cystectomy and standardized extended lymphadenectomy. Five-year overall survival of the cohort was 33%. In univariate analysis, tumour stage (P<0.006), extracapsular extension of lymph node metastases (P<0.001), total diameter of metastases (P<0.04) and lymph node stage (P<0.03) were significantly correlated with overall survival (OS), disease-specific survival (DSS) and recurrence-free survival (RFS). On multivariate analysis, only extracapsular extension (OS, P<0.002; DSS, P<0.02; RFS, P=0.058) and primary tumour stage (OS, P=0.058; DSS, P<0.02; RFS, P<0.02) added independent prognostic information. Extracapsular extension of lymph node metastases did not correlate with a specific recurrence pattern; patients with organ-confined tumours (pT1/2) never had pelvic relapse.
  
  
  CONCLUSIONS
  Extracapsular extension of lymph node metastases but not lymph node tumour burden adds independent prognostic information in lymph node-positive bladder cancer. These biological differences in lymph node-positive bladder cancer are not reflected in the sixth, and challenge future, TNM classification.
authors.affiliation: Department of Pathology, University of Bern, Bern, Switzerland.
authors.forename: Roland
authors.initials: R
authors.lastname: Seiler
authors.forename: Michael
authors.initials: M
authors.lastname: von Gunten
authors.forename: George N
authors.initials: GN
authors.lastname: Thalmann
authors.forename: Achim
authors.initials: A
authors.lastname: Fleischmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000401:mortality / Q000473:pathology*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D047368:Tumor Burden; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology*