Outcomes and prognostic factors in patients with a single lymph node metastasis at time of radical cystectomy.
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Outcomes and prognostic factors in patients with a single lymph node metastasis at time of radical cystectomy. / Rink, Michael; Hansen, Jens; Cha, Eugene K; Green, David A; Babjuk, Marko; Svatek, Robert S; Xylinas, Evanguelos; Tagawa, Scott T; Faison, Talia; Novara, Giacomo; Karakiewicz, Pierre I; Daneshmand, Siamak; Lotan, Yair; Kassouf, Wassim; Fritsche, Hans-Martin; Pycha, Armin; Comploj, Evi; Tilki, Derya; Bastian, Patrick J; Chun, Felix K; Dahlem, Roland; Scherr, Douglas S; Shariat, Shahrokh F.
in: BJU INT, Jahrgang 111, Nr. 1, 1, 2013, S. 74-84.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Outcomes and prognostic factors in patients with a single lymph node metastasis at time of radical cystectomy.
AU - Rink, Michael
AU - Hansen, Jens
AU - Cha, Eugene K
AU - Green, David A
AU - Babjuk, Marko
AU - Svatek, Robert S
AU - Xylinas, Evanguelos
AU - Tagawa, Scott T
AU - Faison, Talia
AU - Novara, Giacomo
AU - Karakiewicz, Pierre I
AU - Daneshmand, Siamak
AU - Lotan, Yair
AU - Kassouf, Wassim
AU - Fritsche, Hans-Martin
AU - Pycha, Armin
AU - Comploj, Evi
AU - Tilki, Derya
AU - Bastian, Patrick J
AU - Chun, Felix K
AU - Dahlem, Roland
AU - Scherr, Douglas S
AU - Shariat, Shahrokh F
N1 - © 2012 The Authors BJU International © 2012 BJU International.
PY - 2013
Y1 - 2013
N2 - OBJECTIVES: To identify clinicopathological factors that predict outcomes in patients with a single lymph node (LN) metastasis (pN1) treated with radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). LN metastasis is an established predictor of clinical outcomes in patients. While most patients with large LN burden experience disease recurrence, lymphadenectomy can be curative in patients with pN1 disease.PATIENTS AND METHODS: We analysed 381 patients with pN1 UCB from a multi-institutional cohort of 4335 patients with UCB treated with RC and lymphadenectomy without preoperative chemo- or radiotherapy. Subgroup analyses were performed for patients with ≥9 LNs removed and according to adjuvant chemotherapy administration (n = 215).RESULTS: The median (interquartile range, IQR) LN number was 15 (19) and the median (IQR) LN density was 6.7 (7.5)%. Within a median follow-up of 41 months, the mean (+/- SD) 2- and 5-year cancer-specific survival (CSS) rates were 55 (3)% and 46 (3)%, respectively. On multivariable analysis that adjusted for the effects of standard clinicopathological features, female gender (hazard ratio [HR] 1.48, P = 0.023), higher tumour stage (HR 1.68, P = 0.007), positive soft tissue surgical margin (STSM; HR 2.06, P = 0.004), higher LN density (HR 2.99, P = 0.025) and absence of adjuvant chemotherapy (HR 0.70, P = 0.026) were independently associated with CSS. In subgroup analyses of patients with ≥9 LNs removed, tumour stage and STSM status remained independent predictors for CSS (P = 0.009 and P < 0.001, respectively).CONCLUSIONS: About half of the patients with pN1 UCB died from UCB within 5 years of RC. Pathological stage and STSM status are strong predictors for outcomes. Accurate prediction of the individual risk of CSS may help risk stratifying pN1 UCB in order to help improve clinical-decision making. Patients with pN1 UCB presenting with additional unfavourable risk factors need a closer follow-up scheduling and might receive adjuvant therapy.
AB - OBJECTIVES: To identify clinicopathological factors that predict outcomes in patients with a single lymph node (LN) metastasis (pN1) treated with radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). LN metastasis is an established predictor of clinical outcomes in patients. While most patients with large LN burden experience disease recurrence, lymphadenectomy can be curative in patients with pN1 disease.PATIENTS AND METHODS: We analysed 381 patients with pN1 UCB from a multi-institutional cohort of 4335 patients with UCB treated with RC and lymphadenectomy without preoperative chemo- or radiotherapy. Subgroup analyses were performed for patients with ≥9 LNs removed and according to adjuvant chemotherapy administration (n = 215).RESULTS: The median (interquartile range, IQR) LN number was 15 (19) and the median (IQR) LN density was 6.7 (7.5)%. Within a median follow-up of 41 months, the mean (+/- SD) 2- and 5-year cancer-specific survival (CSS) rates were 55 (3)% and 46 (3)%, respectively. On multivariable analysis that adjusted for the effects of standard clinicopathological features, female gender (hazard ratio [HR] 1.48, P = 0.023), higher tumour stage (HR 1.68, P = 0.007), positive soft tissue surgical margin (STSM; HR 2.06, P = 0.004), higher LN density (HR 2.99, P = 0.025) and absence of adjuvant chemotherapy (HR 0.70, P = 0.026) were independently associated with CSS. In subgroup analyses of patients with ≥9 LNs removed, tumour stage and STSM status remained independent predictors for CSS (P = 0.009 and P < 0.001, respectively).CONCLUSIONS: About half of the patients with pN1 UCB died from UCB within 5 years of RC. Pathological stage and STSM status are strong predictors for outcomes. Accurate prediction of the individual risk of CSS may help risk stratifying pN1 UCB in order to help improve clinical-decision making. Patients with pN1 UCB presenting with additional unfavourable risk factors need a closer follow-up scheduling and might receive adjuvant therapy.
KW - Adult
KW - Humans
KW - Male
KW - Aged
KW - Female
KW - Middle Aged
KW - Aged, 80 and over
KW - Adolescent
KW - Young Adult
KW - Treatment Outcome
KW - Epidemiologic Methods
KW - Child
KW - Lymphatic Metastasis
KW - Child, Preschool
KW - Infant
KW - Carcinoma in Situ/drug therapy/mortality/pathology/surgery
KW - Chemotherapy, Adjuvant/mortality
KW - Cystectomy/methods/mortality
KW - Lymph Node Excision/mortality
KW - Neoplasm Recurrence, Local/mortality
KW - Urinary Bladder Neoplasms/drug therapy/mortality/pathology/surgery
KW - Adult
KW - Humans
KW - Male
KW - Aged
KW - Female
KW - Middle Aged
KW - Aged, 80 and over
KW - Adolescent
KW - Young Adult
KW - Treatment Outcome
KW - Epidemiologic Methods
KW - Child
KW - Lymphatic Metastasis
KW - Child, Preschool
KW - Infant
KW - Carcinoma in Situ/drug therapy/mortality/pathology/surgery
KW - Chemotherapy, Adjuvant/mortality
KW - Cystectomy/methods/mortality
KW - Lymph Node Excision/mortality
KW - Neoplasm Recurrence, Local/mortality
KW - Urinary Bladder Neoplasms/drug therapy/mortality/pathology/surgery
U2 - 10.1111/j.1464-410X.2012.11356.x
DO - 10.1111/j.1464-410X.2012.11356.x
M3 - SCORING: Journal article
C2 - 22809039
VL - 111
SP - 74
EP - 84
JO - BJU INT
JF - BJU INT
SN - 1464-4096
IS - 1
M1 - 1
ER -