title: Intravesical tumor involvement of the trigone is associated with nodal metastasis in patients undergoing radical cystectomy.
abstract: OBJECTIVE
  To evaluate the influence of intravesical tumor location on nodal metastasis and mortality after cystectomy. The microvascular anatomy of the urinary bladder is variable in distinct regions of the bladder and thus tumor location may influence the tumors' ability to access lymphatic and vascular structures.
  
  
  METHODS
  An observational cohort study was conducted of all patients undergoing radical cystectomy at a single institution between January 2000 and July 2008. Tumor location was classified into the following 6 locations: lateral wall, posterior wall, anterior wall, trigone, dome, and bladder neck. The association between tumor location with nodal metastasis and cancer-specific mortality was assessed.
  
  
  RESULTS
  A total of 545 patients were identified in this cohort. Location of tumor at the bladder trigone was associated with an increased likelihood of nodal metastasis on univariate (odds ratio, 1.63; 95% confidence interval [CI], 1.01-2.62) and multivariate (odds ratio, 1.83; 95% CI 1.11-2.99) analysis. In addition, trigone location was associated with a decreased cancer-specific survival on univariate (hazard ratio, 1.49; 95% CI, 1.03-2.16) and multivariate (hazard ratio, 1.68; 95% CI, 1.11-2.55) analysis.
  
  
  CONCLUSIONS
  Patients with bladder tumor in the trigone have a greater risk of lymph node metastasis at cystectomy and decreased cancer-specific survival. Tumor location may be a useful prognostic factor in risk stratification of patients with invasive bladder cancer.
authors.affiliation: Department of Urology, University of Texas Health Sciences Center - San Antonio, San Antonio, TX.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Svatek
authors.affiliation: Department of Urology, University of Texas Health Sciences Center - San Antonio, San Antonio, TX.
authors.forename: Timothy N
authors.initials: TN
authors.lastname: Clinton
authors.affiliation: Department of Urology, University of Texas - MD Anderson Cancer Center, Houston, TX.
authors.forename: Clark A
authors.initials: CA
authors.lastname: Wilson
authors.affiliation: Department of Urology, University of Texas - MD Anderson Cancer Center, Houston, TX.
authors.forename: Ashish M
authors.initials: AM
authors.lastname: Kamat
authors.affiliation: Department of Urology, University of Texas - MD Anderson Cancer Center, Houston, TX.
authors.forename: H Barton
authors.initials: HB
authors.lastname: Grossman
authors.affiliation: Department of Urology, University of Texas - MD Anderson Cancer Center, Houston, TX.
authors.forename: Colin P
authors.initials: CP
authors.lastname: Dinney
authors.affiliation: Department of Urology, University of Texas - MD Anderson Cancer Center, Houston, TX. Electronic address: jbshah@mdanderson.org.
authors.forename: Jay B
authors.initials: JB
authors.lastname: Shah
mesh_terms: D000368:Aged; D015331:Cohort Studies; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D016016:Proportional Hazards Models; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000098:blood supply / Q000473:pathology / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000098:blood supply / Q000473:pathology / Q000601:surgery*