1980 LYMPH NODE METASTASES ABOVE THE ILIAC BIFURCATION AS AN INDEPENDENT PROGNOSTIC FACTOR IN BLADDER CANCER PATIENTS UNDERGOING RADICAL CYSTECTOMY WITH EXTENDED LYMPH NODE DISSECTION

Abstract

You have accessJournal of UrologyBladder Cancer: Metastatic Disease1 Apr 20111980 LYMPH NODE METASTASES ABOVE THE ILIAC BIFURCATION AS AN INDEPENDENT PROGNOSTIC FACTOR IN BLADDER CANCER PATIENTS UNDERGOING RADICAL CYSTECTOMY WITH EXTENDED LYMPH NODE DISSECTION Ryan Dorin, Pascal Zehnder, Manuel Eisenberg, Jie Cai, Gus Miranda, Donald Skinner, Fiona Burkhard, George Thalmann, Urs Studer, and Eila Skinner Ryan DorinRyan Dorin Los Angeles, CA More articles by this author , Pascal ZehnderPascal Zehnder Bern, Switzerland More articles by this author , Manuel EisenbergManuel Eisenberg Los Angeles, CA More articles by this author , Jie CaiJie Cai Los Angeles, CA More articles by this author , Gus MirandaGus Miranda Los Angeles, CA More articles by this author , Donald SkinnerDonald Skinner Los Angeles, CA More articles by this author , Fiona BurkhardFiona Burkhard Bern, Switzerland More articles by this author , George ThalmannGeorge Thalmann Bern, Switzerland More articles by this author , Urs StuderUrs Studer Bern, Switzerland More articles by this author , and Eila SkinnerEila Skinner Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2206AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The presence of lymph node (LN) metastases in patients undergoing radical cystectomy (RC) for bladder cancer is a well known adverse prognostic indicator. In addition, higher numbers of positive LNs decrease survival in these patients. In this study, we examined the prognostic significance of the proximal extent of LN involvement and other variables affecting survival in a large cohort of RC patients with unexpected LN metastases. METHODS Patients who underwent RC and extended LN dissection (LND) with curative intent at the USC Institute of Urology and the University of Bern (UB) before January 2006 were eligible if all of the following criteria were met: 1) bladder urothelial carcinoma primary, 2) LN metastasis on pathologic exam, 3) M0 disease at time of cystectomy, 4) negative soft tissue margins, and 5) LNs submitted in separate anatomical packets. LN packets were divided into two levels- above the iliac bifurcation (common iliac, presacral, para-aortic, and paracaval LNs), and below the iliac bifurcation (external iliac, internal iliac, obturator, presciatic, Cloquet's nodes). Outcomes data were evaluated in univariate and multivariate analyses. RESULTS 241 patients (66 USC and 175 UB) met inclusion criteria with a median follow up of 6.7 yrs. A median of 28 LNs were identified per patient (range 3–140), and the median number of positive LNs per patient was 2 (range 1–97). The 5 year overall survival (OS) and recurrence free survival (RFS) rates were 33% and 35%, respectively. On univariate analysis, the presence of LN metastasis above the iliac bifurcation was a significant negative predictor of survival with a 5 year OS of 17% vs. 36% for patients with positive LNs below the iliac bifurcation only (hazard ratio (HR)= 1.9, p< 0.001), and a 5 year RFS of 20% vs. 38% (HR= 1.8, p=0.005). When controlled for primary tumor stage, number of positive LNs, and adjuvant chemotherapy in multivariate analysis, the presence of LN metastasis above the iliac bifurcation remained a significant predictor of survival. CONCLUSIONS The presence of LN metastases above the iliac bifurcation is an adverse prognostic indicator in patients undergoing radical cystectomy. This finding supports the value of performing an extended LND at least to the mid common iliac vessels at time of cystectomy. Thorough LND maximizes the prognostic value of surgery in bladder cancer patients with LN metastases. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e792 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ryan Dorin Los Angeles, CA More articles by this author Pascal Zehnder Bern, Switzerland More articles by this author Manuel Eisenberg Los Angeles, CA More articles by this author Jie Cai Los Angeles, CA More articles by this author Gus Miranda Los Angeles, CA More articles by this author Donald Skinner Los Angeles, CA More articles by this author Fiona Burkhard Bern, Switzerland More articles by this author George Thalmann Bern, Switzerland More articles by this author Urs Studer Bern, Switzerland More articles by this author Eila Skinner Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...