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J Clin Oncol. 2008 Jan 1;26(1):121-6. doi: 10.1200/JCO.2007.12.9247.

Lymph node density is superior to TNM nodal status in predicting disease-specific survival after radical cystectomy for bladder cancer: analysis of pooled data from MDACC and MSKCC.

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1
Department of Urology and the Division of Quantitative Sciences, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.

Abstract

PURPOSE:

To compare the utility of lymph node density (LND) with TNM nodal status in predicting disease-specific survival (DSS) after radical cystectomy.

PATIENTS AND METHODS:

We identified 248 patients with nodal metastasis after radical cystectomy (without neoadjuvant chemotherapy): 162 patients from Memorial Sloan-Kettering Cancer Center (MSKCC) and 86 patients from M.D. Anderson Cancer Center (MDACC). We assessed the effect of several variables on DSS.

RESULTS:

After a median follow-up duration of 24 months, 134 patients died of their disease. The median DSS was 36 months, and the 1-year, 2-year, and 5-year DSS rates were 83.7%, 57.4%, and 36.6%, respectively. The median LND was 20%. The 5-year DSS rate was 54.6% for patients with LND < or = 20% v 15.3% for patients with LND higher than 20% (P < .01). Pathologic nodal (pN) status in patients was 78 for pN1 (32%), 127 for pN2 (51%), and 43 for pN3 (17%). On univariate analysis, pN status and LND were significant predictors of DSS (P < .01). However, when pN status and LND were considered jointly in a multivariate model, only LND higher than 20% predicted decreased DSS (hazard ratio [HR], 2.75; P < .01). In addition, while nonorgan-confined (ie, > pT2) primary tumor (HR, 2.40; P < .01) and adjuvant chemotherapy (HR, 0.47; P < .01) were predictors of DSS, LND remained a predictor of DSS even after accounting for adjuvant chemotherapy.

CONCLUSION:

LND is superior to TNM nodal status in predicting DSS for patients with lymph node-positive disease after radical cystectomy, even in the context of adjuvant chemotherapy.

PMID:
18165646
DOI:
10.1200/JCO.2007.12.9247
[Indexed for MEDLINE]
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