Outcomes and prognostic factors in patients with a single lymph node metastasis at time of radical cystectomy.
OBJECTIVE
To identify clinicopathological factors that predict outcomes in patients with a single lymph node (LN) metastasis (pN1) treated with radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). LN metastasis is an established predictor of clinical outcomes in patients. While most patients with large LN burden experience disease recurrence, lymphadenectomy can be curative in patients with pN1 disease.


METHODS
We analysed 381 patients with pN1 UCB from a multi-institutional cohort of 4335 patients with UCB treated with RC and lymphadenectomy without preoperative chemo- or radiotherapy. Subgroup analyses were performed for patients with ≥9 LNs removed and according to adjuvant chemotherapy administration (n = 215).


RESULTS
The median (interquartile range, IQR) LN number was 15 (19) and the median (IQR) LN density was 6.7 (7.5)%. Within a median follow-up of 41 months, the mean (+/- SD) 2- and 5-year cancer-specific survival (CSS) rates were 55 (3)% and 46 (3)%, respectively. On multivariable analysis that adjusted for the effects of standard clinicopathological features, female gender (hazard ratio [HR] 1.48, P = 0.023), higher tumour stage (HR 1.68, P = 0.007), positive soft tissue surgical margin (STSM; HR 2.06, P = 0.004), higher LN density (HR 2.99, P = 0.025) and absence of adjuvant chemotherapy (HR 0.70, P = 0.026) were independently associated with CSS. In subgroup analyses of patients with ≥9 LNs removed, tumour stage and STSM status remained independent predictors for CSS (P = 0.009 and P < 0.001, respectively).


CONCLUSIONS
About half of the patients with pN1 UCB died from UCB within 5 years of RC. Pathological stage and STSM status are strong predictors for outcomes. Accurate prediction of the individual risk of CSS may help risk stratifying pN1 UCB in order to help improve clinical-decision making. Patients with pN1 UCB presenting with additional unfavourable risk factors need a closer follow-up scheduling and might receive adjuvant therapy.
Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY 10065, USA.
Michael
M
Rink
Jens
J
Hansen
Eugene K
EK
Cha
David A
DA
Green
Marko
M
Babjuk
Robert S
RS
Svatek
Evanguelos
E
Xylinas
Scott T
ST
Tagawa
Talia
T
Faison
Giacomo
G
Novara
Pierre I
PI
Karakiewicz
Siamak
S
Daneshmand
Yair
Y
Lotan
Wassim
W
Kassouf
Hans-Martin
HM
Fritsche
Armin
A
Pycha
Evi
E
Comploj
Derya
D
Tilki
Patrick J
PJ
Bastian
Felix K
FK
Chun
Roland
R
Dahlem
Douglas S
DS
Scherr
Shahrokh F
SF
Shariat
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002278:Carcinoma in Situ / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D015653:Cystectomy / Q000379:methods* / Q000401:mortality; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007223:Infant; D008197:Lymph Node Excision / Q000401:mortality; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D055815:Young Adult