title: Is there evidence for a close connection between side of intravesical tumor location and ipsilateral lymphatic spread in lymph node-positive bladder cancer patients at radical cystectomy? Results of the PROMETRICS 2011 database.
abstract: OBJECTIVE
  To evaluate the possible association between bladder tumor location and the laterality of positive lymph nodes (LN) in a prospectively collected multi-institutional radical cystectomy (RC) series.
  
  
  METHODS
  The study population included 148 node-positive bladder cancer (BC) patients undergoing RC and pelvic lymph node dissection in 2011 without neoadjuvant chemotherapy and without distant metastasis. Tumor location was classified as right, left or bilateral and compared to the laterality of positive pelvic LN. A logistic regression model was used to identify predictors of ipsilaterality of lymphatic spread. Using multivariate Cox regression analyses (median follow-up: 25 months), the effect of the laterality of positive LN on cancer-specific mortality (CSM) was estimated.
  
  
  RESULTS
  Overall, median 18.5 LN [interquartile range (IQR), 11-27] were removed and 3 LN (IQR 1-5) were positive. There was concordance of tumor location and laterality of positive LN in 82% [95% confidence interval (CI), 76-89]. Patients with unilateral tumors (n = 78) harbored exclusively ipsilateral positive LN in 67% (95% CI 56-77). No criteria were found to predict ipsilateral positive LN in patients with unilateral tumors. CSM after 3 years in patients with ipsilateral, contralateral, and bilateral LN metastasis was 41, 67, and 100%, respectively (p = 0.042). However, no significant effect of the laterality of positive pelvic LN on CSM could be confirmed in multivariate analyses.
  
  
  CONCLUSIONS
  Our prospective cohort showed a concordance of tumor location and laterality of LN metastasis in BC at RC without any predictive criteria and without any influence on CSM. It is debatable, whether these findings may contribute to a more individualized patient management.
authors.affiliation: Department of Urology, St. Elisabeth-Hospital Straubing, St. Elisabeth-Straße 23, 94315, Straubing, Germany. matthias.may@klinikum-straubing.de.
authors.forename: M
authors.initials: M
authors.lastname: May
authors.affiliation: Department of Urology, University of Rostock, Rostock, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Protzel
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: M W
authors.initials: MW
authors.lastname: Vetterlein
authors.affiliation: Department of Urology, Caritas-Hospital St. Josef, University of Regensburg, Regensburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Gierth
authors.affiliation: Department of Urology, Ruhr-University of Bochum, Marien-Hospital Herne, Herne, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Noldus
authors.affiliation: Department of Urology, Ludwig-Maximilians-University Munich, Munich, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Karl
authors.affiliation: Department of Urology, Ludwig-Maximilians-University Munich, Munich, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Grimm
authors.affiliation: Department of Urology, University of Erlangen, Erlangen, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Wullich
authors.affiliation: Department of Urology, University of Jena, Jena, Germany.
authors.forename: M O
authors.initials: MO
authors.lastname: Grimm
authors.affiliation: Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Nuhn
authors.affiliation: Department of Urology, Marien-Hospital Düsseldorf, Düsseldorf, Germany.
authors.forename: P J
authors.initials: PJ
authors.lastname: Bastian
authors.affiliation: Department of Urology, Vivantes-Clinic Am Friedrichshain, Berlin, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Roigas
authors.affiliation: Department of Urology, University of Heidelberg, Heidelberg, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Hadaschik
authors.affiliation: Department of Urology, St. Elisabeth-Hospital Straubing, St. Elisabeth-Straße 23, 94315, Straubing, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Gilfrich
authors.affiliation: Department of Urology, Caritas-Hospital St. Josef, University of Regensburg, Regensburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Burger
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Fisch
authors.affiliation: Department of Urology, Ludwig-Maximilians-University Munich, Munich, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Brookman-May
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Aziz
authors.affiliation: Department of Urology, University of Rostock, Rostock, Germany.
authors.forename: O W
authors.initials: OW
authors.lastname: Hakenberg
mesh_terms: D000328:Adult; D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D042601:Lymphatic Vessels / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care; D010388:Pelvis / Q000473:pathology*; D016019:Survival Analysis; D001743:Urinary Bladder / Q000473:pathology / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery
keywords: Cystectomy; Laterality of lymph node metastasis; Lymph node dissection; Tumor location; Urinary bladder neoplasms