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Urol Oncol. 2017 Apr;35(4):151.e1-151.e7. doi: 10.1016/j.urolonc.2016.06.021. Epub 2017 Jan 27.

Lymph node density vs. the American Joint Committee on Cancer TNM nodal staging system in node-positive bladder cancer in patients undergoing extended or super-extended pelvic lymphadenectomy.

Author information

1
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
2
Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
3
Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Department of Pathology and Genomic Medicine, The Methodist Hospital, Weil Medical College of Cornell University, Houston, TX.
4
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. Electronic address: igjeong@amc.seoul.kr.

Abstract

PURPOSE:

We compared the prognostic value of the American Joint Committee on Cancer (AJCC) TNM nodal staging system with that of lymph node (LN) density in patients with LN-positive bladder cancer who received extended or super-extended pelvic lymphadenectomy.

METHODS:

Of the 1,018 patients, who underwent radical cystectomy and pelvic lymphadenectomy between February 2005 and August 2014, 110 patients with LN metastases with extended (n = 68) or super-extended (n = 42) pelvic lymphadenectomy were included. All patients were staged using the 2002 (sixth edition) and 2010 (seventh edition) AJCC TNM staging systems. The association of several variables with recurrence-free survival (RFS) and overall survival (OS) was evaluated.

RESULTS:

The median number of total LNs removed was 29 (6-118) and the median LN density was 12.5% (1.6%-100%). RFS and OS were not significantly different between the 2002 (pN1-pM1) and 2010 (pN1-N3) AJCC TNM nodal staging systems (sixth edition: P = 0.512 and P = 0.519; seventh edition: P = 0.676 and P = 0.671, respectively). The 2-year RFS and OS rates according to the LN density quartiles were 58.5% and 76.9% in Q1, 39.1% and 70.8% in Q2, 28.8% and 50.1% in Q3, and 12.7% and 20.8% in Q4 (P = 0.001 and P = 0.001, respectively). Multivariate analysis adjusted for the 2010 AJCC TNM staging system showed that LN density was associated with a decreased OS (HR = 1.024; 95% CI: 1.010-1.039; P = 0.001). The nodal staging system (2002 or 2010) was not associated with the RFS and OS.

CONCLUSIONS:

LN density shows a better prognostic value than the AJCC TNM nodal staging system in patients with LN-positive bladder cancer receiving extended or super-extended pelvic lymphadenectomy.

KEYWORDS:

Lymph node excision; Neoplasm staging; Prognosis; Urinary bladder neoplasm

PMID:
28139370
DOI:
10.1016/j.urolonc.2016.06.021
[Indexed for MEDLINE]

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