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Extranodal extension is a powerful prognostic factor in bladder cancer patients with lymph node metastasis

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Extranodal extension is a powerful prognostic factor in bladder cancer patients with lymph node metastasis. / Fajkovic, Harun; Cha, Eugene K; Jeldres, Claudio; Robinson, Brian D; Rink, Michael; Xylinas, Evanguelos; Chromecki, Thomas F; Breinl, Eckart; Svatek, Robert S; Donner, Gerhard; Tagawa, Scott T; Tilki, Derya; Bastian, Patrick J; Karakiewicz, Pierre I; Volkmer, Bjoern G; Novara, Giacomo; Joual, Abdennabi; Faison, Talia; Sonpavde, Guru; Daneshmand, Siamak; Lotan, Yair; Scherr, Douglas S; Shariat, Shahrokh F.

in: EUR UROL, Jahrgang 64, Nr. 5, 01.11.2013, S. 837-45.

Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung

Harvard

Fajkovic, H, Cha, EK, Jeldres, C, Robinson, BD, Rink, M, Xylinas, E, Chromecki, TF, Breinl, E, Svatek, RS, Donner, G, Tagawa, ST, Tilki, D, Bastian, PJ, Karakiewicz, PI, Volkmer, BG, Novara, G, Joual, A, Faison, T, Sonpavde, G, Daneshmand, S, Lotan, Y, Scherr, DS & Shariat, SF 2013, 'Extranodal extension is a powerful prognostic factor in bladder cancer patients with lymph node metastasis', EUR UROL, Jg. 64, Nr. 5, S. 837-45. https://doi.org/10.1016/j.eururo.2012.07.026

APA

Fajkovic, H., Cha, E. K., Jeldres, C., Robinson, B. D., Rink, M., Xylinas, E., Chromecki, T. F., Breinl, E., Svatek, R. S., Donner, G., Tagawa, S. T., Tilki, D., Bastian, P. J., Karakiewicz, P. I., Volkmer, B. G., Novara, G., Joual, A., Faison, T., Sonpavde, G., ... Shariat, S. F. (2013). Extranodal extension is a powerful prognostic factor in bladder cancer patients with lymph node metastasis. EUR UROL, 64(5), 837-45. https://doi.org/10.1016/j.eururo.2012.07.026

Vancouver

Fajkovic H, Cha EK, Jeldres C, Robinson BD, Rink M, Xylinas E et al. Extranodal extension is a powerful prognostic factor in bladder cancer patients with lymph node metastasis. EUR UROL. 2013 Nov 1;64(5):837-45. https://doi.org/10.1016/j.eururo.2012.07.026

Bibtex

@article{c49670e1311e48b4acadf7108d699fe1,
title = "Extranodal extension is a powerful prognostic factor in bladder cancer patients with lymph node metastasis",
abstract = "BACKGROUND: Lymph node metastasis (LNM) is the most powerful pathologic predictor of disease recurrence after radical cystectomy (RC). However, the outcomes of patients with LNM are highly variable.OBJECTIVE: To assess the prognostic value of extranodal extension (ENE) and other lymph node (LN) parameters.DESIGN, SETTING, AND PARTICIPANTS: A retrospective analysis of 748 patients with urothelial carcinoma of the bladder and LNM treated with RC and lymphadenectomy without neoadjuvant therapy at 10 European and North American centers (median follow-up: 27 mo).INTERVENTION: All subjects underwent RC and bilateral pelvic lymphadenectomy.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Each LNM was microscopically evaluated for the presence of ENE. The number of LNs removed, number of positive LNs, and LN density were recorded and calculated. Univariable and multivariable analyses addressed time to disease recurrence and cancer-specific mortality after RC.RESULTS AND LIMITATIONS: A total of 375 patients (50.1%) had ENE. The median number of LNs removed, number of positive LNs, and LN density were 15, 2, and 15, respectively. The rate of ENE increased with advancing pT stage (p<0.001). In multivariable Cox regression analyses that adjusted for the effects of established clinicopathologic features and LN parameters, ENE was associated with disease recurrence (hazard ratio [HR]: 1.89; 95% confidence interval [CI], 1.55-2.31; p<0.001) and cancer-specific mortality (HR: 1.90; 95% CI, 1.52-2.37; p<0.001). The addition of ENE to a multivariable model that included pT stage, tumor grade, age, gender, lymphovascular invasion, surgical margin status, LN density, number of LNs removed, number of positive LNs, and adjuvant chemotherapy improved predictive accuracy for disease recurrence and cancer-specific mortality from 70.3% to 77.8% (p<0.001) and from 71.8% to 77.8% (p=0.007), respectively. The main limitation of the study is its retrospective nature.CONCLUSIONS: ENE is an independent predictor of both cancer recurrence and cancer-specific mortality in RC patients with LNM. Knowledge of ENE status could help with patient counseling, clinical decision making regarding inclusion in clinical trials of adjuvant therapy, and tailored follow-up scheduling after RC.",
author = "Harun Fajkovic and Cha, {Eugene K} and Claudio Jeldres and Robinson, {Brian D} and Michael Rink and Evanguelos Xylinas and Chromecki, {Thomas F} and Eckart Breinl and Svatek, {Robert S} and Gerhard Donner and Tagawa, {Scott T} and Derya Tilki and Bastian, {Patrick J} and Karakiewicz, {Pierre I} and Volkmer, {Bjoern G} and Giacomo Novara and Abdennabi Joual and Talia Faison and Guru Sonpavde and Siamak Daneshmand and Yair Lotan and Scherr, {Douglas S} and Shariat, {Shahrokh F}",
note = "Copyright {\textcopyright} 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.",
year = "2013",
month = nov,
day = "1",
doi = "10.1016/j.eururo.2012.07.026",
language = "English",
volume = "64",
pages = "837--45",
journal = "EUR UROL",
issn = "0302-2838",
publisher = "Elsevier",
number = "5",

}

RIS

TY - JOUR

T1 - Extranodal extension is a powerful prognostic factor in bladder cancer patients with lymph node metastasis

AU - Fajkovic, Harun

AU - Cha, Eugene K

AU - Jeldres, Claudio

AU - Robinson, Brian D

AU - Rink, Michael

AU - Xylinas, Evanguelos

AU - Chromecki, Thomas F

AU - Breinl, Eckart

AU - Svatek, Robert S

AU - Donner, Gerhard

AU - Tagawa, Scott T

AU - Tilki, Derya

AU - Bastian, Patrick J

AU - Karakiewicz, Pierre I

AU - Volkmer, Bjoern G

AU - Novara, Giacomo

AU - Joual, Abdennabi

AU - Faison, Talia

AU - Sonpavde, Guru

AU - Daneshmand, Siamak

AU - Lotan, Yair

AU - Scherr, Douglas S

AU - Shariat, Shahrokh F

N1 - Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.

PY - 2013/11/1

Y1 - 2013/11/1

N2 - BACKGROUND: Lymph node metastasis (LNM) is the most powerful pathologic predictor of disease recurrence after radical cystectomy (RC). However, the outcomes of patients with LNM are highly variable.OBJECTIVE: To assess the prognostic value of extranodal extension (ENE) and other lymph node (LN) parameters.DESIGN, SETTING, AND PARTICIPANTS: A retrospective analysis of 748 patients with urothelial carcinoma of the bladder and LNM treated with RC and lymphadenectomy without neoadjuvant therapy at 10 European and North American centers (median follow-up: 27 mo).INTERVENTION: All subjects underwent RC and bilateral pelvic lymphadenectomy.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Each LNM was microscopically evaluated for the presence of ENE. The number of LNs removed, number of positive LNs, and LN density were recorded and calculated. Univariable and multivariable analyses addressed time to disease recurrence and cancer-specific mortality after RC.RESULTS AND LIMITATIONS: A total of 375 patients (50.1%) had ENE. The median number of LNs removed, number of positive LNs, and LN density were 15, 2, and 15, respectively. The rate of ENE increased with advancing pT stage (p<0.001). In multivariable Cox regression analyses that adjusted for the effects of established clinicopathologic features and LN parameters, ENE was associated with disease recurrence (hazard ratio [HR]: 1.89; 95% confidence interval [CI], 1.55-2.31; p<0.001) and cancer-specific mortality (HR: 1.90; 95% CI, 1.52-2.37; p<0.001). The addition of ENE to a multivariable model that included pT stage, tumor grade, age, gender, lymphovascular invasion, surgical margin status, LN density, number of LNs removed, number of positive LNs, and adjuvant chemotherapy improved predictive accuracy for disease recurrence and cancer-specific mortality from 70.3% to 77.8% (p<0.001) and from 71.8% to 77.8% (p=0.007), respectively. The main limitation of the study is its retrospective nature.CONCLUSIONS: ENE is an independent predictor of both cancer recurrence and cancer-specific mortality in RC patients with LNM. Knowledge of ENE status could help with patient counseling, clinical decision making regarding inclusion in clinical trials of adjuvant therapy, and tailored follow-up scheduling after RC.

AB - BACKGROUND: Lymph node metastasis (LNM) is the most powerful pathologic predictor of disease recurrence after radical cystectomy (RC). However, the outcomes of patients with LNM are highly variable.OBJECTIVE: To assess the prognostic value of extranodal extension (ENE) and other lymph node (LN) parameters.DESIGN, SETTING, AND PARTICIPANTS: A retrospective analysis of 748 patients with urothelial carcinoma of the bladder and LNM treated with RC and lymphadenectomy without neoadjuvant therapy at 10 European and North American centers (median follow-up: 27 mo).INTERVENTION: All subjects underwent RC and bilateral pelvic lymphadenectomy.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Each LNM was microscopically evaluated for the presence of ENE. The number of LNs removed, number of positive LNs, and LN density were recorded and calculated. Univariable and multivariable analyses addressed time to disease recurrence and cancer-specific mortality after RC.RESULTS AND LIMITATIONS: A total of 375 patients (50.1%) had ENE. The median number of LNs removed, number of positive LNs, and LN density were 15, 2, and 15, respectively. The rate of ENE increased with advancing pT stage (p<0.001). In multivariable Cox regression analyses that adjusted for the effects of established clinicopathologic features and LN parameters, ENE was associated with disease recurrence (hazard ratio [HR]: 1.89; 95% confidence interval [CI], 1.55-2.31; p<0.001) and cancer-specific mortality (HR: 1.90; 95% CI, 1.52-2.37; p<0.001). The addition of ENE to a multivariable model that included pT stage, tumor grade, age, gender, lymphovascular invasion, surgical margin status, LN density, number of LNs removed, number of positive LNs, and adjuvant chemotherapy improved predictive accuracy for disease recurrence and cancer-specific mortality from 70.3% to 77.8% (p<0.001) and from 71.8% to 77.8% (p=0.007), respectively. The main limitation of the study is its retrospective nature.CONCLUSIONS: ENE is an independent predictor of both cancer recurrence and cancer-specific mortality in RC patients with LNM. Knowledge of ENE status could help with patient counseling, clinical decision making regarding inclusion in clinical trials of adjuvant therapy, and tailored follow-up scheduling after RC.

U2 - 10.1016/j.eururo.2012.07.026

DO - 10.1016/j.eururo.2012.07.026

M3 - SCORING: Journal article

C2 - 22877503

VL - 64

SP - 837

EP - 845

JO - EUR UROL

JF - EUR UROL

SN - 0302-2838

IS - 5

ER -