title: Clinical and pathological nodal staging score for urothelial carcinoma of the bladder: an external validation.
abstract: OBJECTIVE
  Radical cystectomy (RC) and pelvic lymph node dissection (LND) are standard treatments for muscle-invasive urothelial carcinoma of the bladder. Lymph node staging is a prerequisite for clinical decision-making regarding adjuvant chemotherapy and follow-up regimens. Recently, the clinical and pathological nodal staging scores (cNSS and pNSS) were developed. Prior to RC, cNSS determines the minimum number of lymph nodes required to be dissected; pNSS quantifies the accuracy of negative nodal staging based on pT stage and dissected LNs. cNSS and pNSS have not been externally validated, and their relevance for prediction of cancer-specific mortality (CSM) has not been assessed.
  
  
  METHODS
  In this retrospective study of 2,483 RC patients from eight German centers, we externally validated cNSS and pNSS and determined their prediction of CSM. All patients underwent RC and LND. Median follow-up was 44 months. cNSS and pNSS sensitivities were evaluated using the original beta-binominal models. Adjusted proportional hazards models were calculated for pN0 patients to assess the predictive value of cNSS and pNSS for CSM.
  
  
  RESULTS
  cNSS and pNSS both pass external validation. Adjusted for other clinical parameters, cNSS can predict outcome after RC. pNSS has no independent impact on prediction of CSM. The retrospective design is the major limitation of the study.
  
  
  CONCLUSIONS
  In the present external validation, we confirm the validity of both cNSS and pNSS. cNSS is an independent predictor of CSM, thus rendering it useful as a tool for planning the extent of LND.
authors.affiliation: Department of Urology, University of Regensburg, Regensburg, Germany, Michael.Gierth@gmx.de.
authors.forename: M
authors.initials: M
authors.lastname: Gierth
authors.forename: H M
authors.initials: HM
authors.lastname: Fritsche
authors.forename: H
authors.initials: H
authors.lastname: Buchner
authors.forename: M
authors.initials: M
authors.lastname: May
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authors.lastname: Aziz
authors.forename: W
authors.initials: W
authors.lastname: Otto
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authors.initials: C
authors.lastname: Bolenz
authors.forename: L
authors.initials: L
authors.lastname: Trojan
authors.forename: E
authors.initials: E
authors.lastname: Hermann
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authors.initials: A
authors.lastname: Tiemann
authors.forename: S C
authors.initials: SC
authors.lastname: Müller
authors.forename: J
authors.initials: J
authors.lastname: Ellinger
authors.forename: S
authors.initials: S
authors.lastname: Brookman-May
authors.forename: C G
authors.initials: CG
authors.lastname: Stief
authors.forename: D
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authors.lastname: Tilki
authors.forename: P
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authors.lastname: Nuhn
authors.forename: T
authors.initials: T
authors.lastname: Höfner
authors.forename: M
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authors.lastname: Hohenfellner
authors.forename: A
authors.initials: A
authors.lastname: Haferkamp
authors.forename: J
authors.initials: J
authors.lastname: Roigas
authors.forename: M
authors.initials: M
authors.lastname: Zacharias
authors.forename: W F
authors.initials: WF
authors.lastname: Wieland
authors.forename: H
authors.initials: H
authors.lastname: Riedmiller
authors.forename: S
authors.initials: S
authors.lastname: Denzinger
authors.forename: P J
authors.initials: PJ
authors.lastname: Bastian
authors.forename: M
authors.initials: M
authors.lastname: Burger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000473:pathology* / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D015653:Cystectomy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010388:Pelvis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000628:therapy