title: Prognostic value of computed tomography before radical cystectomy in patients with invasive bladder cancer: imaging predicts survival.
abstract: OBJECTIVE
  Computed tomography (CT) is current standard-of-care for preoperative staging in patients with invasive bladder cancer before radical cystectomy (RC). There are only sparse data on the association between preoperative CT findings and postoperative survival of patients.
  
  
  METHODS
  We retrospectively evaluated preoperative CTs of 206 patients with invasive bladder cancer undergoing RC in an academic tertiary referral center. CTs were analyzed retrospectively for relative bladder wall thickness (BWT) and size of lymph nodes (LN). Associations between CT findings and risk of death from any cause (AC) as well as risk of death from bladder cancer (BC) were assessed by Kaplan-Meier estimates, cumulative incidence curves and multivariable Cox regression analysis.
  
  
  RESULTS
  The median follow-up was 40 months. Increased BWT was significantly correlated with higher risk of death (AC: HR 1.68; p = 0.043; BC: HR 2.00; p = 0.027), as well as LN with a size of 6-10 mm (AC: HR 2.13; p = 0.002; BC: HR 2.77; p = 0.002) and >10 mm (AC: HR 2.47; p = 0.018; BC: HR 3.66; p = 0.007) when compared to LN ≤ 5 mm.
  
  
  CONCLUSIONS
  Our data showed a significant correlation of bladder wall thickness and LN size with the risk of death. Also lymph nodes >5 mm but ≤ 10 mm (resp. ≤ 8 mm)-usually considered non-pathologic-were associated with a significantly worse prognosis. This information can be used to counsel patients preoperatively. It might also be useful for a risk-adapted approach in regard to neoadjuvant chemotherapy.
authors.affiliation: Department of Urology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. sebastian.schmid@lrz.tum.de.
authors.forename: Sebastian Christoph
authors.initials: SC
authors.lastname: Schmid
authors.affiliation: Institute for Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Tina
authors.initials: T
authors.lastname: Zahel
authors.affiliation: Institute for Medical Statistics and Epidemiology, Technische Universität München, Munich, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Haller
authors.affiliation: Department of Urology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Horn
authors.affiliation: Department of Urology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
authors.forename: Ilja
authors.initials: I
authors.lastname: Metzger
authors.affiliation: Institute for Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Konstantin
authors.initials: K
authors.lastname: Holzapfel
authors.affiliation: Department of Urology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
authors.forename: Anna K
authors.initials: AK
authors.lastname: Seitz
authors.affiliation: Department of Urology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
authors.forename: Jürgen Erich
authors.initials: JE
authors.lastname: Gschwend
authors.affiliation: Department of Urology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
authors.forename: Margitta
authors.initials: M
authors.lastname: Retz
authors.affiliation: Department of Urology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Maurer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery
keywords: Bladder cancer; CT scan; Computed tomography; Computerized tomography; Cystectomy; Imaging; Prognosis; Survival