Impact of perivesical lymph nodes on survival after radical cystectomy.

Abstract

350 Background: Lymph node staging for bladder cancer is dependent upon both location and number. This study characterizes perivesical (PV) lymph nodes (LN) found at radical cystectomy and evaluates their prognostic impact. Methods: We reviewed our Institutional Review Board-approved database from 1971-2009 including all patients who underwent radical cystectomy with pelvic lymphadenectomy for curative intent for urothelial carcinoma. Clinical and pathologic data were obtained. Patients were analyzed in three groups: PV LN+/other LN-, PV LN+/other LN+, and PV LN-/other LN+. Kaplan-Meier curves were used to estimate recurrence free survival (RFS) and overall survival (OS). Multivariable Cox regression (including pathologic T stage, number of positive LN, highest level of positive LN, chemotherapy, and margin status) was performed to evaluate associations between PV LN status and survival. Results: A total of 2,045 patients underwent radical cystectomy for urothelial carcinoma of which 2011 met inclusion criteria. PV LN were identified in 936 (47%) patients, positive in 197 (10%) patients, and represented isolated LN positive disease in 101 (5%) patients. On univariate analysis, positive PV LN were associated with a higher likelihood of extravesical disease (>pT2) when compared with other positive LN (p=0.023). There was no significant difference in RFS or OS when comparing patients with negative PV LN to those with PV LN not identified. On multivariable analysis, patients with PV LN+/other LN+ had a significantly worse RFS (HR 1.75, 95% CI 1.29-2.38, p<0.001) and OS (HR 1.66, 95% CI 1.27-2.19, p<0.001) when compared with PV LN-/other LN+. There was no significant difference in RFS or OS when comparing patients with PV LN+/other LN- to PV LN-/other LN+. Conclusions: PV LN are identified in a significant portion of patients after radical cystectomy with pelvic lymphadenectomy. Positive PV LN, when in combination with other positive LN, portends worse survival even when correcting for the number of positive LN. No significant difference in survival was seen comparing patients with isolated positive PV LN to those with other positive LN. This study highlights the importance of PV LN in pathologic analysis and bladder cancer staging.