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Clinical prognosticators of survival in patients with urothelial carcinoma of the bladder and lymph node metastases after cystectomy with curative intent

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Abstract

Introduction

Patients with lymph node-positive urothelial carcinoma of the bladder generally have a poor prognosis. Nevertheless, long-term survival in up to 30 % of patients is reported. In the absence of established prognostic molecular markers, an assessment of the prognosis with clinical parameters is mandatory.

Patients and methods

All patients from one high-volume center with a curatively intended cystectomy for lymph node-positive urothelial carcinoma were evaluated. Patients’ overall and cancer-specific survival were correlated with clinicopathological parameters. Pathological lymph node staging was performed with both the 2002 and 2010 TNM classification of the AJCC.

Results

Lack of a perioperative chemotherapy (p < 0.001), higher numbers of positive nodes (p = 0.002), a higher lymph node density (p = 0.003), a higher pathological T stage (p = 0.006) and urinary diversion with an ileal conduit compared to an ileal neobladder (p = 0.023) were prognostic of a shorter overall survival while the number of removed lymph nodes showed no significant association with survival. Both with the 2002 and 2010 TNM classifications patients staged pN1 had a longer overall survival and time to cancer-specific death in comparison to patients with more extensive lymph node disease. According to the 2002 classification, there was a significant survival difference between patients with lymph node metastases in regional and distant lymph nodes.

Discussion

Patients with a low lymph node density and an early pT stage present with the best prognosis among LN positive patients. The value of perioperative chemotherapy is emphasized. Which lymph node metastases are to be considered regional or distant remains a matter of debate.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

This analysis has been approved by the local ethics committee (Application Number 5891/13) and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Authors and Affiliations

  1. Department of Urology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

    Thomas Horn, Sebastian C. Schmid, Anna K. Seitz, Jessica Grab, Margitta Retz, Tobias Maurer, Michael Autenrieth, Hubert R. Kübler & Jürgen E. Gschwend

  2. Institute of Medical Statistics and Epidemiology, Technische Universität München, Munich, Germany

    Petra Wolf & Bernhard Haller

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  1. Thomas Horn
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  2. Sebastian C. Schmid
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  3. Anna K. Seitz
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  11. Jürgen E. Gschwend
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Correspondence to Thomas Horn.

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Horn, T., Schmid, S.C., Seitz, A.K. et al. Clinical prognosticators of survival in patients with urothelial carcinoma of the bladder and lymph node metastases after cystectomy with curative intent. World J Urol 33, 813–819 (2015). https://doi.org/10.1007/s00345-014-1355-9

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  • DOI: https://doi.org/10.1007/s00345-014-1355-9

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