title: Extracapsular Extension of Pelvic Lymph Node Metastasis is an Independent Prognostic Factor in Bladder Cancer: A Systematic Review and Meta-analysis.
abstract: OBJECTIVE
  We aimed to elucidate the relation between extracapsular extension (ECE) and clinical outcomes in node-positive patients following radical cystectomy for bladder cancer.
  
  
  METHODS
  Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched PubMed, SCOPUS, Web of Science, and Cochrane Library databases from their respective dates of inception until September 2014.
  
  
  RESULTS
  Ten articles that met the eligibility criteria included 43-748 subjects per study, with the total number of patients being 1,893. The frequency of ECE ranged from 36.6 to 58.1 %. The pooled hazard ratio (HR) was statistically significant for recurrence-free survival (RFS) [pooled HR 1.56; 95 % confidence interval (CI) 1.13-2.14] and cancer-specific survival (CSS) (pooled HR 1.60; 95 % CI 1.29-1.99) but not overall survival (OS) (pooled HR 1.47; 95 % CI 0.71-3.05). Heterogeneity in RFS (I (2) 84 %, p < 0.00001) and OS (I (2) 80 %, p = 0.03) was statistically significant. According to subgroup analysis with meta-regression analyses, "region" (pheterogeneity < 0.0001) and "analysis results" (pheterogeneity < 0.0001) were the sources of heterogeneity. Sensitivity analysis showed that omission of any study did not lead to a significant difference. No statistical evidence of publication bias regarding RFS or CSS was revealed among the studies using Begg's and Egger's tests.
  
  
  CONCLUSIONS
  This meta-analysis shows that ECE is an efficient prognostic factor for node-positive bladder cancer. However, large prospective studies are needed to confirm the clinical utility of ECE as an independent prognostic factor before these results can be applied clinically.
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Tae Sik
authors.initials: TS
authors.lastname: Ahn
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Hyung Suk
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Chang Wook
authors.initials: CW
authors.lastname: Jeong
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Cheol
authors.initials: C
authors.lastname: Kwak
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Hyeon Hoe
authors.initials: HH
authors.lastname: Kim
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Korea. kuuro70@snu.ac.kr.
authors.forename: Ja Hyeon
authors.initials: JH
authors.lastname: Ku
mesh_terms: D018572:Disease-Free Survival; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D010388:Pelvis; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000473:pathology*