Abstract
BackgroundPerivesical lymph nodes (PVLNs) are occasionally isolated during grossing of cystectomy specimens. However, the prognostic implications of the involvement of PVLNs in bladder cancer patients, especially those with comparisons to pN0 disease, remain poorly understood.MethodsA retrospective review identified 115 radical cystectomy cases where PVLNs had been histologically assessed. These cases were then divided into 4 groups – Group 1 (n = 76): PVLN-negative/other pelvic lymph node (non-PVLN)-negative; Group 2 (n = 5): PVLN-positive/non-PVLN-negative; Group 3 (n = 17): PVLN-negative/non-PVLN-positive; and Group 4 (n = 17): PVLN-positive/non-PVLN-positive.ResultspT stage at cystectomy was significantly higher in Group 3 (P = 0.013), Group 4 (P < 0.001), Groups 2 and 4 (P < 0.001), or Groups 2–4 (P < 0.001) than in Group 1. However, the number of positive PVLNs (mean: 1.8 vs. 2.1; P = 0.718) or the rate of extracapsular extension in the PVLNs (40% vs. 65%, P = 0.609) was not significantly different between Group 2 and Group 4. Kaplan-Meier analysis and log-rank test revealed significantly (P < 0.05) higher risks of disease progression (Group 3/Group 4), cancer-specific mortality (Group 2/Group 3/Group 4), and overall mortality (Group 4), compared with Group 1. Multivariate analysis further showed metastasis to both PVLN and non-PVLN (Group 4), PVLN (Groups 2 and 4), or PVLN and/or non-PVLN (Groups 2–4) as an independent prognosticator for cancer-specific mortality and overall survival. There were also insignificant (P = 0.096) and significant (P = 0.036) differences in cancer-specific survival and overall survival, respectively, between Group 3 versus Group 4, and the trend of the latter was confirmed by subset multivariate analysis (hazard ratio = 3.769; P = 0.099).ConclusionsWorse prognosis was observed in bladder cancer patients with isolated PVLN metastasis (vs. pN0 disease especially for cancer-specific survival), PVLN metastasis with or without non-PVLN metastasis (vs. pN0 disease), and concurrent PVLN and non-PVLN metastases (vs. PVLN-negative/non-PVLN-positive disease especially for overall survival). These findings indicate the importance of thorough histopathological assessment of PVLNs in radical cystectomy specimens.
Highlights
Perivesical lymph nodes (PVLNs) are occasionally isolated during grossing of cystectomy specimens
Worse prognosis was observed in bladder cancer patients with isolated PVLN metastasis, PVLN metastasis with or without non-PVLN metastasis, and concurrent PVLN and non-PVLN metastases
These findings indicate the importance of thorough histopathological assessment of PVLNs in radical cystectomy specimens
Summary
Perivesical lymph nodes (PVLNs) are occasionally isolated during grossing of cystectomy specimens. The prognostic implications of the involvement of PVLNs in bladder cancer patients, especially those with comparisons to pN0 disease, remain poorly understood. It has been well documented that metastasis to the regional lymph node(s) represents a critical prognostic factor in patients with bladder cancer. Radical cystectomy usually with pelvic lymph node dissection remains the mainstay of treatment for locally advanced bladder cancer. The prognostic implications of perivesical lymph node (PVLN) involvement by bladder cancer metastasis remain far from being fully understood. No recent studies have assessed the clinical significance of PVLN involvement in patients with bladder cancer, especially with comparisons to N0 disease. We here comparatively studied the outcome of groups of patients with or without positive PVLN and/or non-PVLN who underwent radical cystectomy and pelvic lymphadenectomy for bladder cancer
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