Pathologic nodal staging score for bladder cancer: a decision tool for adjuvant therapy after radical cystectomy.

TY - JOUR

T1 - Pathologic nodal staging score for bladder cancer: a decision tool for adjuvant therapy after radical cystectomy.

AU - Shariat, Shahrokh F

AU - Rink, Michael

AU - Ehdaie, Behfar

AU - Xylinas, Evanguelos

AU - Babjuk, Marek

AU - Merseburger, Axel S

AU - Svatek, Robert S

AU - Cha, Eugene K

AU - Tagawa, Scott T

AU - Fajkovic, Harun

AU - Novara, Giacomo

AU - Karakiewicz, Pierre I

AU - Trinh, Quoc-Dien

AU - Daneshmand, Siamak

AU - Lotan, Yair

AU - Kassouf, Wassim

AU - Fritsche, Hans-Martin

AU - Chun, Felix K

AU - Sonpavde, Guru

AU - Joual, Abdennabi

AU - Scherr, Douglas S

AU - Gonen, Mithat

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

PY - 2013

Y1 - 2013

N2 - BACKGROUND: Radical cystectomy (RC) with pelvic lymph node dissection (PLND) is the standard of care for high-risk non-muscle-invasive and muscle-invasive bladder cancer (BCa).OBJECTIVE: To develop a model that allows quantification of the likelihood that a pathologically node-negative patient has, indeed, no positive nodes.DESIGN, SETTING, AND PARTICIPANTS: We analyzed data from 4335 patients treated with RC and PLND without neoadjuvant chemotherapy at 12 international academic centers.INTERVENTIONS: Patients underwent RC and PLND.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We estimated the sensitivity of pathologic nodal staging using a beta-binomial model and developed a pathologic (postoperative) nodal staging score (pNSS) that represents the probability that a patient is correctly staged as node negative as a function of the number of examined nodes.RESULTS AND LIMITATIONS: Overall, the probability of missing a positive node decreases with the increasing number of nodes examined (52% if 3 nodes are examined, 40% if 5 are examined, and 26% if 10 are examined). The proportion of having a positive node increased proportionally with advancing pathologic T stage and lymphovascular invasion (LVI). Patients with LVI who had 25 examined nodes would have a pNSS of 80% (pT1), 88% (pT2), and 66% (pT3-T4), whereas 10 examined nodes were sufficient for pNSS exceeding 90% in patients without LVI and pT0-T2 tumors. This study is limited because of its retrospective design and multicenter nature.CONCLUSIONS: We developed a tool that estimates the likelihood of lymph node (LN) metastasis in BCa patients treated with RC by evaluating the number of examined nodes, the pathologic T stage, and LVI. The pNSS indicates the adequacy of nodal staging in LN-negative patients. This tool could help to refine clinical decision making regarding adjuvant chemotherapy, follow-up scheduling, and inclusion in clinical trials.

AB - BACKGROUND: Radical cystectomy (RC) with pelvic lymph node dissection (PLND) is the standard of care for high-risk non-muscle-invasive and muscle-invasive bladder cancer (BCa).OBJECTIVE: To develop a model that allows quantification of the likelihood that a pathologically node-negative patient has, indeed, no positive nodes.DESIGN, SETTING, AND PARTICIPANTS: We analyzed data from 4335 patients treated with RC and PLND without neoadjuvant chemotherapy at 12 international academic centers.INTERVENTIONS: Patients underwent RC and PLND.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We estimated the sensitivity of pathologic nodal staging using a beta-binomial model and developed a pathologic (postoperative) nodal staging score (pNSS) that represents the probability that a patient is correctly staged as node negative as a function of the number of examined nodes.RESULTS AND LIMITATIONS: Overall, the probability of missing a positive node decreases with the increasing number of nodes examined (52% if 3 nodes are examined, 40% if 5 are examined, and 26% if 10 are examined). The proportion of having a positive node increased proportionally with advancing pathologic T stage and lymphovascular invasion (LVI). Patients with LVI who had 25 examined nodes would have a pNSS of 80% (pT1), 88% (pT2), and 66% (pT3-T4), whereas 10 examined nodes were sufficient for pNSS exceeding 90% in patients without LVI and pT0-T2 tumors. This study is limited because of its retrospective design and multicenter nature.CONCLUSIONS: We developed a tool that estimates the likelihood of lymph node (LN) metastasis in BCa patients treated with RC by evaluating the number of examined nodes, the pathologic T stage, and LVI. The pNSS indicates the adequacy of nodal staging in LN-negative patients. This tool could help to refine clinical decision making regarding adjuvant chemotherapy, follow-up scheduling, and inclusion in clinical trials.

KW - Adult

KW - Humans

KW - Male

KW - Aged

KW - Female

KW - Middle Aged

KW - Aged, 80 and over

KW - Young Adult

KW - Cohort Studies

KW - Lymphatic Metastasis

KW - Pelvis

KW - Retrospective Studies

KW - Neoplasm Staging

KW - Likelihood Functions

KW - Decision Support Techniques

KW - Cystectomy/methods

KW - Lymph Nodes/pathology/surgery

KW - Carcinoma/drug therapy/pathology/surgery

KW - Chemotherapy, Adjuvant/methods

KW - Lymph Node Excision/methods

KW - Urinary Bladder Neoplasms/drug therapy/pathology/surgery

KW - Urothelium

KW - Adult

KW - Humans

KW - Male

KW - Aged

KW - Female

KW - Middle Aged

KW - Aged, 80 and over

KW - Young Adult

KW - Cohort Studies

KW - Lymphatic Metastasis

KW - Pelvis

KW - Retrospective Studies

KW - Neoplasm Staging

KW - Likelihood Functions

KW - Decision Support Techniques

KW - Cystectomy/methods

KW - Lymph Nodes/pathology/surgery

KW - Carcinoma/drug therapy/pathology/surgery

KW - Chemotherapy, Adjuvant/methods

KW - Lymph Node Excision/methods

KW - Urinary Bladder Neoplasms/drug therapy/pathology/surgery

KW - Urothelium

U2 - 10.1016/j.eururo.2012.06.008

DO - 10.1016/j.eururo.2012.06.008

M3 - SCORING: Journal article

C2 - 22727174

VL - 63

SP - 371

EP - 378

JO - EUR UROL

JF - EUR UROL

SN - 0302-2838

IS - 2

M1 - 2

ER -