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Association Between the Number of Dissected Lymph Nodes During Pelvic Lymphadenectomy and Cancer-Specific Survival in Patients with Lymph Node–Negative Urothelial Carcinoma of the Bladder Undergoing Radical Cystectomy

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

A larger number of dissected lymph nodes (LN) during pelvic lymphadenectomy in patients with muscle-invasive transitional-cell carcinoma of the bladder treated by radical cystectomy (RC) is crucial for exact tumor staging and is associated with a positive oncological outcome.

Methods

Clinical and pathological records of 1291 patients undergoing RC due to LN-negative transitional-cell carcinoma of the bladder were summarized and evaluated in a multi-institutional database. The number of removed LNs and the presence or absence of lymphovascular invasion were assessed. On the basis of multivariate Cox regression analyses, a threshold number of removed LNs was defined that exerted an independent influence on cancer-specific survival (CSS).

Results

In multivariate Cox regression models for different numbers of removed LNs, a statistically significant enhancement of CSS could be demonstrated for a LN count of 16. Furthermore, the integration of the dichotomized LN count of 16 resulted in a statistically significantly enhanced predictive ability of the model for CSS. Patients with <16 and ≥16 removed LNs showed CSS rates after 5 years of 72% and 83%, respectively (P = 0.01). In addition, age, sex, pT stage, and lymphovascular invasion had independent influences on CSS in every Cox regression model.

Conclusions

In patients undergoing RC, removal of a higher LN count is associated with an improved oncological outcome. The information resulting from an assessment of lymphovascular invasion and an extended lymphadenectomy is critical for stratification of risk groups and identification of patients who might benefit from adjuvant treatment.

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Authors and Affiliations

  1. Department of Urology, St. Elisabeth Klinikum Straubing, Straubing, Germany

    Matthias May MD & Christian Gilfrich MD

  2. Urologische Universitätsklinik, Universität Münster, Münster, Germany

    Edwin Herrmann MD, PhD, Arne Tiemann MD, Rudolf Moritz MD & Christian Wülfing MD, PhD

  3. Urologische Universitätsklinik, Universität Heidelberg, Mannheim, Germany

    Christian Bolenz MD, Lutz Trojan MD. PhD & Maurice S. Michel MD, PhD

  4. Klinik für Urologie der Universität Regensburg, Caritas Krankenhaus St. Josef, Regensburg, Germany

    Sabine Brookman-May MD, Hans-Martin Fritsche MD, Maximilian Burger MD, PhD & Wolf F. Wieland MD, PhD

  5. Urologische Universitätsklinik, Universität Bonn, Bonn, Germany

    Stefan C. Müller MD, PhD & Jörg Ellinger MD

  6. Urologische Universitätsklinik, LMU München, München, Germany

    Alexander Buchner MD, Christian G. Stief MD, PhD, Derya Tilki MD, PhD & Patrick J. Bastian MD, PhD

  7. Urologische Universitätsklinik, Universität Heidelberg, Heidelberg, Germany

    Thomas Höfner MD & Markus Hohenfellner MD, PhD

  8. Urologische Universitätsklinik, Universität Frankfurt/Main, Frankfurt/Main, Germany

    Axel Haferkamp MD, PhD

  9. Urologische Klinik, Vivantes Kliniken Am Urban und Im Friedrichshain Berlin, Berlin, Germany

    Jan Roigas MD, PhD

  10. Urologische Klinik, Vivantes Klinikum AVK Berlin, Berlin, Germany

    Mario Zacharias MD

Authors
  1. Matthias May MD
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  2. Edwin Herrmann MD, PhD
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  3. Christian Bolenz MD
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  4. Sabine Brookman-May MD
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  8. Maximilian Burger MD, PhD
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  9. Lutz Trojan MD. PhD
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  10. Maurice S. Michel MD, PhD
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  14. Alexander Buchner MD
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  15. Christian G. Stief MD, PhD
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  16. Derya Tilki MD, PhD
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  17. Wolf F. Wieland MD, PhD
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  18. Christian Gilfrich MD
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  19. Thomas Höfner MD
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  20. Markus Hohenfellner MD, PhD
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  21. Axel Haferkamp MD, PhD
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  22. Jan Roigas MD, PhD
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  23. Mario Zacharias MD
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  24. Patrick J. Bastian MD, PhD
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Corresponding author

Correspondence to Matthias May MD.

Additional information

Matthias May and Edwin Herrmann contributed equally to this work.

The authors declare no conflict of interest.

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May, M., Herrmann, E., Bolenz, C. et al. Association Between the Number of Dissected Lymph Nodes During Pelvic Lymphadenectomy and Cancer-Specific Survival in Patients with Lymph Node–Negative Urothelial Carcinoma of the Bladder Undergoing Radical Cystectomy. Ann Surg Oncol 18, 2018–2025 (2011). https://doi.org/10.1245/s10434-010-1538-6

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  • DOI: https://doi.org/10.1245/s10434-010-1538-6

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