title: Lymphadenectomy with radical cystectomy at an Australian tertiary referral institution: time trends and impact on oncological outcomes.
abstract: BACKGROUND
  Lymph node dissection (LND) with radical cystectomy (RC) for surgical treatment of invasive urothelial carcinoma of the bladder can improve staging and has possible therapeutic benefit. The aim of this study was to assess utilization and extent of LND with RC at our institution and determine its impact on oncological outcomes.
  
  
  METHODS
  Using surgical databases and hospital coding, clinical and histopathological characteristics of 87 patients who underwent RC at Austin Health between 2004 and 2011 were retrospectively analysed. Associations of predictor variables with LND use and lymph node (LN) status were analysed using logistic regression. Survival analyses were undertaken using Cox proportional hazard models.
  
  
  RESULTS
  Fifty-eight (65.9%) patients underwent LND, with a clear trend over time in the proportion of patients undergoing LND (three of seven in 2004 up to 10 of 10 in 2011, P < 0.001) and the median (range) of LN yield from five (2-19) in 2004 to 18 (7-35) in 2011 (P < 0.001). Year of treatment was the only significant predictor (univariately and multivariately) of a patient undergoing LND. Multivariately, a significant association with nodal metastases was found for cN stage and planned extent of LND preoperatively, and pT stage postoperatively. LN status was associated significantly with recurrence-free survival with best outcomes in patients who were node-negative on a pelvic LND. A similar trend was seen for cancer-specific survival (P = 0.053).
  
  
  CONCLUSIONS
  Over the study period, there was an increase in the use of pelvic LND and LN numbers retrieved during RC. LN status appears to impact on recurrence-free survival, and possibly cancer-specific survival.
authors.affiliation: Department of Urology, Austin Health, Melbourne, Victoria, Australia.
authors.forename: Renu
authors.initials: R
authors.lastname: Eapen
authors.affiliation: Ludwig Institute for Cancer Research, Melbourne, Victoria, Australia.|Joint Austin-Ludwig Oncology Unit, Austin Health, Melbourne, Victoria, Australia.
authors.forename: Mun Sem
authors.initials: MS
authors.lastname: Liew
authors.affiliation: Joint Austin-Ludwig Oncology Unit, Austin Health, Melbourne, Victoria, Australia.
authors.forename: Ali
authors.initials: A
authors.lastname: Tafreshi
authors.affiliation: Department of Urology, Austin Health, Melbourne, Victoria, Australia.
authors.forename: Nathan
authors.initials: N
authors.lastname: Papa
authors.affiliation: Department of Urology, Austin Health, Melbourne, Victoria, Australia.|Ludwig Institute for Cancer Research, Melbourne, Victoria, Australia.|Austin Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Nathan
authors.initials: N
authors.lastname: Lawrentschuk
authors.affiliation: Joint Austin-Ludwig Oncology Unit, Austin Health, Melbourne, Victoria, Australia.
authors.forename: Arun
authors.initials: A
authors.lastname: Azad
authors.affiliation: Ludwig Institute for Cancer Research, Melbourne, Victoria, Australia.|Joint Austin-Ludwig Oncology Unit, Austin Health, Melbourne, Victoria, Australia.|Austin Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.|Monash University Eastern Health Clinical School, Melbourne, Victoria, Australia.
authors.forename: Ian D
authors.initials: ID
authors.lastname: Davis
authors.affiliation: Department of Urology, Austin Health, Melbourne, Victoria, Australia.|Ludwig Institute for Cancer Research, Melbourne, Victoria, Australia.|Austin Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Damien
authors.initials: D
authors.lastname: Bolton
authors.affiliation: Department of Urology, Austin Health, Melbourne, Victoria, Australia.|Ludwig Institute for Cancer Research, Melbourne, Victoria, Australia.|Austin Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Shomik
authors.initials: S
authors.lastname: Sengupta
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016019:Survival Analysis; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D014739:Victoria / Q000453:epidemiology
keywords: bladder cancer; lymphadenectomy; recurrence; survival; time trend