title: Clinical prognosticators of survival in patients with urothelial carcinoma of the bladder and lymph node metastases after cystectomy with curative intent.
abstract: BACKGROUND
  Patients with lymph node-positive urothelial carcinoma of the bladder generally have a poor prognosis. Nevertheless, long-term survival in up to 30% of patients is reported. In the absence of established prognostic molecular markers, an assessment of the prognosis with clinical parameters is mandatory.
  
  
  METHODS
  All patients from one high-volume center with a curatively intended cystectomy for lymph node-positive urothelial carcinoma were evaluated. Patients' overall and cancer-specific survival were correlated with clinicopathological parameters. Pathological lymph node staging was performed with both the 2002 and 2010 TNM classification of the AJCC.
  
  
  RESULTS
  Lack of a perioperative chemotherapy (p < 0.001), higher numbers of positive nodes (p = 0.002), a higher lymph node density (p = 0.003), a higher pathological T stage (p = 0.006) and urinary diversion with an ileal conduit compared to an ileal neobladder (p = 0.023) were prognostic of a shorter overall survival while the number of removed lymph nodes showed no significant association with survival. Both with the 2002 and 2010 TNM classifications patients staged pN1 had a longer overall survival and time to cancer-specific death in comparison to patients with more extensive lymph node disease. According to the 2002 classification, there was a significant survival difference between patients with lymph node metastases in regional and distant lymph nodes.
  
  
  CONCLUSIONS
  Patients with a low lymph node density and an early pT stage present with the best prognosis among LN positive patients. The value of perioperative chemotherapy is emphasized. Which lymph node metastases are to be considered regional or distant remains a matter of debate.
authors.affiliation: Department of Urology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany, t.horn@lrz.tum.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Horn
authors.forename: Sebastian C
authors.initials: SC
authors.lastname: Schmid
authors.forename: Anna K
authors.initials: AK
authors.lastname: Seitz
authors.forename: Jessica
authors.initials: J
authors.lastname: Grab
authors.forename: Petra
authors.initials: P
authors.lastname: Wolf
authors.forename: Bernhard
authors.initials: B
authors.lastname: Haller
authors.forename: Margitta
authors.initials: M
authors.lastname: Retz
authors.forename: Tobias
authors.initials: T
authors.lastname: Maurer
authors.forename: Michael
authors.initials: M
authors.lastname: Autenrieth
authors.forename: Hubert R
authors.initials: HR
authors.lastname: Kübler
authors.forename: Jürgen E
authors.initials: JE
authors.lastname: Gschwend
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data*; D015331:Cohort Studies; D015653:Cystectomy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D014547:Urinary Diversion / Q000379:methods*