title: Does skip metastasis or other lymph node parameters have additional effects on survival of patients undergoing radical cystectomy for bladder cancer?
abstract: OBJECTIVE
  To investigate the effects of lymph node metastasis, skip metastasis, and other factors related to lymph node status on survival in patients who underwent radical cystectomy (RC) and extended lymph node dissection (eLND).
  
  
  METHODS
  RC and eLND were performed in 85 patients with a diagnosis of bladder cancer. Disease-free survival (DFS) and overall survival (OS) were determined by using a Cox proportional hazards model that included the number of excised lymph nodes, the presence of pathological lymph node metastasis, the anatomical level of positive nodes, the number of positive lymph nodes, lymph node density, and the presence of skip metastasis.
  
  
  RESULTS
  The mean number of lymph nodes removed per patient was 29.4±9.3. Lymph node positivity was detected in 85 patients (34.1%). The mean follow-up duration was 44.9±27.4 months (2-93 months). Five-year estimated OS and DFS for the 85 patients were 62.6% and 57%, respectively. Three of 29 lymph node-positive patients (10.3%) had skip metastasis. Only lymph node positivity had a significant effect on 5-year OS and DFS (p<0.001). No difference in OS and DFS was found between the three patients with skip metastasis and other lymph node-positive patients. Other factors related to lymph node status had no significant effect on 5-year OS and DFS.
  
  
  CONCLUSIONS
  No factors related to lymph node status predict DFS and OS, except for lymph node positivity. OS and DFS were comparable between patients with skip metastasis and other lymph node-positive patients.
authors.affiliation: Department of Urology, Private Akay Hospital, Ankara, Turkey.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Ugurlu
authors.affiliation: Department of Urology, Faculty of Medicine, Ankara University, Ankara, Turkey.
authors.forename: Sumer
authors.initials: S
authors.lastname: Baltaci
authors.affiliation: Department of Urology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
authors.forename: Guven
authors.initials: G
authors.lastname: Aslan
authors.affiliation: Department of Urology, Eskişehir Osmangazi University Medical Faculty, Eskişehir, Turkey.
authors.forename: Cavit
authors.initials: C
authors.lastname: Can
authors.affiliation: Department of Urology, Ege University Medical Faculty, Izmir, Turkey.
authors.forename: Cag
authors.initials: C
authors.lastname: Cal
authors.affiliation: Department of Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey.
authors.forename: Atilla
authors.initials: A
authors.lastname: Elhan
authors.affiliation: Department of Urology, Marmara University School of Medicine, Istanbul, Turkey.
authors.forename: Levent
authors.initials: L
authors.lastname: Turkeri
authors.affiliation: Department of Urology, Karaelmas University, School of Medicine, Zonguldak, Turkey.
authors.forename: Aydin
authors.initials: A
authors.lastname: Mungan
mesh_terms: D000328:Adult; D000368:Aged; D015653:Cystectomy; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000473:pathology*; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*
keywords: Lymph node excision; Treatment outcome; Urinary bladder neoplasms