1874 EXTERNAL VALIDATION OF EXTRANODAL EXTENSION AND LYMPH NODE DENSITY AS PREDICTORS OF SURVIVAL IN NODE POSITIVE BLADDER CANCER AFTER RADICAL CYSTECTOMY

Abstract

You have accessJournal of UrologyBladder Cancer: Metastatic Disease + Staging1 Apr 20131874 EXTERNAL VALIDATION OF EXTRANODAL EXTENSION AND LYMPH NODE DENSITY AS PREDICTORS OF SURVIVAL IN NODE POSITIVE BLADDER CANCER AFTER RADICAL CYSTECTOMY Alexandra Masson-Lecomte, Dimitri Vordos, Andras Hoznek, René Yiou, Yves Allory, Claude Abbou, Alexandre de la Taille, and Laurent Salomon Alexandra Masson-LecomteAlexandra Masson-Lecomte Creteil, France More articles by this author , Dimitri VordosDimitri Vordos Créteil, France More articles by this author , Andras HoznekAndras Hoznek Créteil, France More articles by this author , René YiouRené Yiou Créteil, France More articles by this author , Yves AlloryYves Allory Créteil, France More articles by this author , Claude AbbouClaude Abbou Créteil, France More articles by this author , Alexandre de la TailleAlexandre de la Taille Créteil, France More articles by this author , and Laurent SalomonLaurent Salomon Créteil, France More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2293AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prognostic factors in pathologic N+ patients after radical cystectomy (RC) are debated. Previous studies suggested extra nodal extension (ENE) and lymph node density (LND) to be strong predictors of survival. The aim of this study was to assess factors predictive of survival and to evaluate the prognostic significance of the TNM nodal classification in a retrospective cohort of node positive bladder cancers after RC. METHODS We retrospectively reviewed the data of 75 patients with node positive bladder cancer after RC. Node pathological examination was performed by two experienced uropathologists. Cox regression analysis was performed to identify factors predictive of progression. RESULTS The median number of removed lymph node was 18 (3-49). The median number of positive lymph nodes was 3 (1-35). Overall 5-year progression free and cancer specific survival (CSS) were 5 and 12%. CSS was 28% in the LND<20% group versus 8% in the LND> 20% group (p=0.03) and CSS was 34% in the absence of ENE group versus 0% in the ENE group (p=0.03). Patients presenting both favorable features (LND<20% and absence of ENE; 17% of patients) had a 3-year cancer specific survival of 48% versus 0% when one or both unfavorable characteristics were present (LND>20% and/or ENE)(p<0.0001, Figure). In multivariate analysis, ENE, lymph node density with a 20% cut off and adjuvant chemotherapy were independent predictors of progression free survival (p=0.007, 0.006, <0.0001). Neither 2002 nor 2009 TNM nodal classification were associated with recurrence. CONCLUSIONS ENE and lymph node density are strong predictors of clinical outcome in patients with node positive bladder cancer treated by cystectomy. The actual TNM classification could probably be improved using these criteria, allowing better prognostic classification of node positive bladder cancer after radical cystectomy. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e768-e769 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexandra Masson-Lecomte Creteil, France More articles by this author Dimitri Vordos Créteil, France More articles by this author Andras Hoznek Créteil, France More articles by this author René Yiou Créteil, France More articles by this author Yves Allory Créteil, France More articles by this author Claude Abbou Créteil, France More articles by this author Alexandre de la Taille Créteil, France More articles by this author Laurent Salomon Créteil, France More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...