title: The number of nodes removed as well as the template of the dissection is independently correlated to cancer-specific survival after radical cystectomy for muscle-invasive bladder cancer.
abstract: OBJECTIVE
  To assess the impact of the number of lymph nodes removed and of the template of dissection during radical cystectomy for bladder cancer on patients' survival rates.
  
  
  METHODS
  We evaluated 282 consecutive patients who underwent radical cystectomy for muscle-invasive or high-grade superficial bladder cancer between 1995 and 2011. Exclusion criteria were incomplete follow-up data and neo-adjuvant or adjuvant treatments. Patients were divided into groups according to the most informative cut-point of number of lymph nodes retrieved and of the template of dissection. The cancer-specific survival rates were estimated by the Kaplan-Meier method. The univariate and multivariable forward-stepwise Cox proportional hazards regression were applied to analyze the survival outcomes.
  
  
  RESULTS
  The mean (SD) follow-up was 59.2 ± 44.3 months, and the mean (SD) age of the entire cohort population was 68.3 ± 8.3 years. The cancer-specific survival rates were 58.7 and 47.7 % at 5 and 10 years, respectively. Considering both node-positive and node-negative patients, those with at least 14 LNs removed and those submitted to extended or super-extended PLND experienced significantly higher cancer-specific survival at both univariate and multivariable analysis.
  
  
  CONCLUSIONS
  Patients undergoing a more extended pelvic lymph node dissection, both in terms of number of LN removed and in terms of template of dissection, will experience a better cancer-specific survival. Our data support a potential role of lymphadenectomy on cancer outcome.
authors.affiliation: Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Palagi 9 Street, 40134, Bologna, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Brunocilla
authors.forename: Remigio
authors.initials: R
authors.lastname: Pernetti
authors.forename: Riccardo
authors.initials: R
authors.lastname: Schiavina
authors.forename: Marco
authors.initials: M
authors.lastname: Borghesi
authors.forename: Valerio
authors.initials: V
authors.lastname: Vagnoni
authors.forename: Giovanni Christian
authors.initials: GC
authors.lastname: Rocca
authors.forename: Filippo
authors.initials: F
authors.lastname: Borgatti
authors.forename: Sergio
authors.initials: S
authors.lastname: Concetti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Martorana
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D010388:Pelvis; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery