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Scoring system for prediction of lymph node metastasis in radical cystectomy cohort

  • Urology - Original Paper
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Abstract

Objectives

The objective of the study was to assess whether pretreatment clinical parameters combined with computed tomography can improve the prediction of lymph node metastasis in patients with bladder cancer treated with radical cystectomy.

Patients and methods

In a single-center retrospective study, demographic and clinicopathological information (initial transurethral resection [grade, stage, multiplicity of tumors, lymphovascular invasion], hydronephrosis, abdominal and pelvic computed tomography) and the presence of lymph node disease on final pathology of 183 patients with bladder cancer undergoing radical cystectomy and pelvic lymph node dissection were reviewed. Logistic regression and bootstrap methods were used to create an integer score for estimating the risk of positive lymph nodes. Various measures for predictive ability and clinical utility were determined.

Results

On pathological examination, 59.6 % of patients had positive lymph nodes. In a multivariable analysis, status lymph nodes on computed tomography and hydronephrosis were the most strongly associated predictors. The resultant total possible score ranged from 0 to 10, with a cut-off value of >4 points. The area under the receiver operating characteristic curve was 0.806. Relative integrated discrimination improvement was 14.3 %. In the decision curve analysis, the model provided net benefit throughout the entire range of threshold probabilities. However, the final model was roughly equivalent to using the clinical exam.

Conclusions

The pre-cystectomy scoring system improved the prediction of lymph node status in patients with bladder cancer. Our model represented a user-friendly staging aid, but a large multi-center study should be performed before widespread implementation.

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Abbreviations

AUC:

Area under the receiver operating characteristic curve

BC:

Bladder cancer

CI:

Confidential interval

CT:

Computed tomography

ePLND:

Extended pelvic LND

IDI:

Integrated discrimination improvement

IP:

The integrated 1-specificity

IS:

The integrated sensitivity

LN:

Lymph node

LND:

Lymph node dissection

LVI:

Lymphovascular invasion

MRI:

Magnetic resonance imaging

MI:

Muscle-invasive

NC:

Neoadjuvant chemotherapy

NPV:

Negative predictive value

NRI:

Net reclassification improvement

ORs:

Odds ratios

pN+:

Lymph node metastases

ROC:

The receiver operating characteristic curve

PPV:

Positive predictive value

TUR:

Transurethral resection

TURBT:

Transurethral resection of bladder tumor

References

  1. Karl A, Carroll PR, Gschwend JE et al (2009) The impact of lymphadenectomy and lymph node metastasis on the outcomes of radical cystectomy for bladder cancer. Eur Urol 55:826–835

    Article  PubMed  Google Scholar 

  2. Vikram R, Sandler CM, Ng CS (2009) Imaging and staging of transitional cell carcinoma: part 1, lower urinary tract. Am J Roentgenol 192:1481–1487

    Article  Google Scholar 

  3. Youssef RF, Raj GV (2011) Lymphadenectomy in management of invasive bladder cancer. Int J Surg Oncol, 758189. Published online: Jun 16. doi:10.1155/2011/758189

  4. Kim JK, Park SY, Ahn HJ, Kim CS, Cho KS (2004) Bladder cancer: analysis of multi-detector row helical CT enhancement pattern and accuracy in tumor detection and perivesical staging. Radiology 231:725–731

    Article  PubMed  Google Scholar 

  5. Xie HY, Zhu Y, Yao XD et al (2012) Development of a nomogram to predict non-organ-confined bladder urothelial cancer before radical cystectomy. Int Urol Nephrol 44:1711–1719

    Article  PubMed  Google Scholar 

  6. Green DA, Rink M, Hansen J, et al (2012) Accurate preoperative prediction of non-organ-confined bladder urothelial carcinoma at cystectomy. BJU Int. Published online: Jul 13. doi:10.1111/j.1464-410X.2012.11370.x

  7. Karakiewicz PI, Shariat SF, Palapattu GS et al (2006) Precystectomy nomogram for prediction of advanced bladder cancer stage. Eur Urol 50:1254–1262

    Article  PubMed  Google Scholar 

  8. Ahmadi H, Mitra AP, Abdelsayed GA, et al (2012) Principal component analysis based pre-cystectomy model to predict pathological stage in patients with clinical organ-confined bladder cancer. BJU Int. Published online: Oct 4. doi:10.1111/j.1464-410X.2012.11502.x

  9. Margel D, Harel A, Yossepowitch O, Baniel J (2009) A novel algorithm to improve pathologic stage prediction of clinically organ-confined muscle-invasive bladder cancer. Cancer 115:1459–1464

    Article  PubMed  Google Scholar 

  10. Mitra AP, Skinner EC, Miranda G, Daneshmand S (2013) A precystectomy decision model to predict pathological upstaging and oncological outcomes in clinical stage T2 bladder cancer. BJU Int 111:240–248

    Article  PubMed  Google Scholar 

  11. Rink M, Hansen J, Cha EK et al (2013) Outcomes and prognostic factors in patients with a single lymph node metastasis at time of radical cystectomy. BJU Int 111:74–84

    Article  PubMed  Google Scholar 

  12. McLaughlin S, Shephard J, Wallen E, Maygarden S, Carson CC, Pruthi RS (2007) Comparison of the clinical and pathologic staging in patients undergoing radical cystectomy for bladder cancer. Int Braz J Urol 33:25–31

    Article  PubMed  Google Scholar 

  13. Haleblian GE, Skinner EC, Dickinson MG, Lieskovsky G, Boyd SD, Skinner DG (1998) Hydronephrosis as a prognostic indicator in bladder cancer patients. J Urol 160:2011–2014

    Article  CAS  PubMed  Google Scholar 

  14. Sobin LH, Gospodariwicz M, Wittekind C (1973) TNM classification of malignant tumors. UICC international union against cancer, 7 edn. Wiley, London, 2009

  15. Mostofi FK, Sobin LH, Torloni H (1973) Histological typing of urinary bladder tumours. World Health Organization, Geneva

    Google Scholar 

  16. Quek ML, Stein JP, Nichols PW et al (2005) Prognostic significance of lymphovascular invasion of bladder cancer treated with radical cystectomy. J Urol 174:103–106

    Article  PubMed  Google Scholar 

  17. Eisenhauer EA, Therasse P, Bogaerts J et al (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247

    Article  CAS  PubMed  Google Scholar 

  18. Altman D, Royston P (2000) What do we mean by validating a prognostic model? Stat Med 19:453–473

    Article  CAS  PubMed  Google Scholar 

  19. Pickering JW, Endre ZH (2012) New metrics for assessing diagnostic potential of candidate biomarkers. Clin J Am Soc Nephrol 7:1355–1364

    Article  PubMed  Google Scholar 

  20. Vickers AJ, Elkin EB (2006) Decision curve analysis: a novel method for evaluating prediction models. Med Decis Making 26:565–574

    Article  PubMed Central  PubMed  Google Scholar 

  21. Turker P, Bostrom PJ, Wroclawski ML et al (2012) Upstaging of urothelial cancer at the time of radical cystectomy: factors associated with upstaging and its effect on outcome. BJU Int 110:804–811

    Article  PubMed  Google Scholar 

  22. Matsumoto K, Shariat SF, Casella R, Wheeler TM, Slawin KM, Lerner SP (2003) Preoperative plasma soluble E-cadherin predicts metastases to lymph nodes and prognosis in patients undergoing radical cystectomy. J Urol 170:2248–2252

    Article  CAS  PubMed  Google Scholar 

  23. Suzuki K, Morita T, Tokue A (2005) Vascular endothelial growth factor-C (VEGF-C) expression predicts lymph node metastasis of transitional cell carcinoma of the bladder. Int J Urol 12:152–158

    Article  CAS  PubMed  Google Scholar 

  24. Smith SC, Baras AS, Dancik G et al (2011) A 20-gene model for molecular nodal staging of bladder cancer: development and prospective assessment. Lancet Oncol 12:137–143

    Article  PubMed Central  PubMed  Google Scholar 

  25. Abdel-Latif M, Abol-Enein H, El-Baz M, Ghoneim MA (2004) Nodal involvement in bladder cancer cases treated with radical cystectomy: incidence and prognosis. J Urol 172:85–89

    Article  PubMed  Google Scholar 

  26. Stimson CJ, Cookson MS, Barocas DA et al (2010) Preoperative hydronephrosis predicts extravesical and node positive disease in patients undergoing cystectomy for bladder cancer. J Urol 183:1732–1737

    Article  CAS  PubMed  Google Scholar 

  27. May M, Burger M, Brookman-May S et al (2011) Validation of pre-cystectomy nomograms for the prediction of locally advanced urothelial bladder cancer in a multicentre study: are we able to adequately predict locally advanced tumour stages before surgery? Der Urol Ausg A 50:706–713

    Article  CAS  Google Scholar 

  28. Niegisch G, Lorch A, Droller MJ, Lavery HJ, Stensland KD, Albers P (2013) Neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer: which patients benefit? Eur Urol. Published online: Jun 12. doi:10.1016/j.eururo.2013.06.002

  29. Ploeg M, Kiemeney LA, Smits GA et al (2012) Discrepancy between clinical staging through bimanual palpation and pathological staging after cystectomy. Urol Oncol 30:247–251

    Article  PubMed  Google Scholar 

  30. Abol-Enein H, El-Baz M, Abd El-Hameed MA, Abdel-Latif M, Ghoneim MA (2004) Lymph node involvement in patients with bladder cancer treated with radical cystectomy: a patho-anatomical study–a single center experience. J Urol 172:1818–1821

    Article  PubMed  Google Scholar 

  31. Shariat SF, Ehdaie B, Rink M et al (2012) Clinical nodal staging scores for bladder cancer: a proposal for preoperative risk assessment. Eur Urol 61:237–242

    Article  PubMed  Google Scholar 

  32. Shariat SF, Rink M, Ehdaie B et al (2013) Pathologic nodal staging score for bladder cancer: a decision tool for adjuvant therapy after radical cystectomy. Eur Urol 63:371–378

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors were financially supported through a research grant N0175014 of the Ministry of Science and Technological Development of Serbia. The authors thank the Ministry for this support.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Urology, Clinic of Urology and Nephrology, Clinical Centre “Kragujevac”, Zmaj Jovina 30, 34000, Kragujevac, Serbia

    Miroslav M. Stojadinović

  2. Clinic of Urology, Military Medical Academy, Belgrade, Serbia

    Rade Prelević

  3. Faculty of Engineering, University of Kragujevac, Kragujevac, Serbia

    Arso Vukićević

Authors
  1. Miroslav M. Stojadinović
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  2. Rade Prelević
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  3. Arso Vukićević
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Correspondence to Miroslav M. Stojadinović.

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Stojadinović, M.M., Prelević, R. & Vukićević, A. Scoring system for prediction of lymph node metastasis in radical cystectomy cohort. Int Urol Nephrol 46, 1317–1323 (2014). https://doi.org/10.1007/s11255-014-0645-x

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  • DOI: https://doi.org/10.1007/s11255-014-0645-x

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