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Eur Urol. 2012 Feb;61(2):237-42. doi: 10.1016/j.eururo.2011.10.011. Epub 2011 Oct 21.

Clinical nodal staging scores for bladder cancer: a proposal for preoperative risk assessment.

Author information

1
Brady Urologic Health Center, Weill Cornell Medical College, 525 East 68th St., Box 94, Starr 900, New York, NY 10065, USA. sfshariat@gmail.com

Abstract

BACKGROUND:

Radical cystectomy (RC) with pelvic lymph node dissection (LND) is the standard of care for refractory non-muscle-invasive and muscle-invasive bladder cancer. Although consensus exists on the need for LND, its extent is still debated.

OBJECTIVE:

To develop a model that allows preoperative determination of the minimum number of lymph nodes (LNs) needed to be removed at RC to ensure true nodal status.

DESIGN, SETTING, AND PARTICIPANTS:

We analyzed data from 4335 patients treated with RC and pelvic LND without neoadjuvant chemotherapy at 12 academic centers located in the United States, Canada, and Europe.

MEASUREMENTS:

We estimated the sensitivity of pathologic nodal staging using a beta-binomial model and developed clinical (preoperative) nodal staging scores (cNSS), which represent the probability that a patient has LN metastasis as a function of the number of examined nodes.

RESULTS AND LIMITATIONS:

The probability of missing a positive LN decreased with an increasing number of nodes examined (52% if 3 nodes were examined, 40% if 5 were examined, and 26% if 10 were examined). A cNSS of 90% was achieved by examining 6 nodes for clinical Ta-Tis tumors, 9 nodes for cT1 tumors, and 25 nodes for cT2 tumors. In contrast, examination of 25 nodes provided only 77% cNSS for cT3-T4 tumors. The study is limited due to its retrospective design, its multicenter nature, and a lack of preoperative staging parameters.

CONCLUSIONS:

Every patient treated with RC for bladder cancer needs an LND to ensure accurate nodal staging. The minimum number of examined LNs for adequate staging depends preoperatively on the clinical T stage. Predictive tools can give a preoperative estimation of the likelihood of nodal metastasis and thereby allow tailored decision-making regarding the extent of LND at RC.

PMID:
22033174
DOI:
10.1016/j.eururo.2011.10.011
[Indexed for MEDLINE]

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