Abstract
Objective To evaluate the minimum number of lymph nodes(LN)required for optimal staging at radical cystectomy specimens analysis from patients with bladder cancer and to analyze the frequency of LN metastases among different anatomic regions. Methods From Jan. 2008 to Jan. 2015, a total of 197 patients underwent super-extended pelvic lymph nodes dissection were recruited, and their clinical data were reviewed, icluding 53cases(47male and 3 female patients) with positive LN . The super-extended pelvic lymph nodes dissection were divided into 10 regions as well as 6 groups according to the anatomic sites, including the external iliac, internal iliac, obturator and bilateral common lilac lymph nodes, the presacral lymph nodes and above the aortic bifurcation lymph nodes. Particular attention was paid to the total number of LN examined, the number and location of LN with metastases (positive LN), lymph node metastasis rate and lymph nodes density in the cystectomy specimen. According to the lymph node density(LND) of lymph node metastasis cases, minimum removal of lymph node number is 1/LND. The recurrence and survival was followed up. Results A total of 197 radical cystectomies with 8 513 LN were reviewed, including 53(26.9 %) LNs positive cases, with 244 positive LN out of the 1 528 LNs (16.0%). The average number of LN examined in each case was 29.4±11.9, and the average number of positive LNs identified in each case was 4.7±3.9. Among all of the LNs, the internal iliac /obturator LN were the most commonly submitted (23.8%/19.7%) and the external iliac /obturator LN were the highest number of positive LNs (20.9%/27.5%). On average, for cases staged N1 and N2, there was one positive LN per 18(1/0.056)and 11(1/0.195×2)LN examined from the primary drainage LN, respectively. For N3 cases, one out of 5 (1/0.211)secondary drainage LN was found to be positive. Similarly, one out of 4(1/0.251)distant LN was found to be positive in cases with M1 staging . On average, 23 LN(at least 16LN) including 18(at least 11) primary drainage LN and five secondary drainage LN should be submitted for optimal N staging. For adequate M1 staging, an average of four distal LN should be evaluated. One hundred and twenty-nine cases were followed up for an average of 37.7 months, with tumor recurrence was 33 cases (25.6%), overall survival 87.6% (113/129). Conclusion A minimum of 20 and 27 LNs should be examined in radical cystectomy specimens in order to achieve accurate N and M staging. Key words: Urothelial carcinoma; Bladder; Lymphnode; Pathologic staging
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call