NSU-MD Faculty Articles
Pelvic lymph node dissection can be curative in patients with node positive bladder cancer.
Publication Title
The Journal of urology
Publisher
Elsevier Inc.
ISSN
0022-5347
Publication Date
2-1-1999
Keywords
Actuarial Analysis, Adult, Aged, Aged, 80 and over, Cohort Studies, Female, Humans, Lymph Node Excision, Lymphatic Metastasis, Male, Middle Aged, Remission Induction, Retrospective Studies, Survival Rate, Treatment Outcome, Urinary Bladder Neoplasms
Abstract
PURPOSE: We analyze outcome in a large cohort of patients with bladder cancer metastatic to the regional lymph nodes using disease specific survival as the end point.
MATERIALS AND METHODS: To identify predictors for outcome a large series of 193 consecutive patients with regional lymph node metastases operated on from 1980 to 1990 at Memorial Sloan-Kettering Cancer Center was retrospectively analyzed.
RESULTS: Among various clinical and pathological parameters, univariate and multivariate analyses identified only P (p = 0.0001) and N categories (p = 0.0006) as parameters predicting disease specific survival. In patients who received chemotherapy or irradiation either as part of a nonrandomized clinical protocol or on an ad hoc basis no beneficial impact on disease specific survival could be demonstrated. Survival was also not affected by pathological grade and other histological parameters, since pathological features in patients with node positive bladder cancer are uniformly shifted towards high grade lesions with vascular or lymphatic invasion and a solid appearance on histological analysis.
CONCLUSIONS: Nodal metastases carry a poor prognosis despite pelvic lymphadenectomy and radical cystectomy. Nevertheless, some node positive cases with otherwise localized bladder cancer and/or low N category appear to benefit from surgery. Our findings of improved outcome in some individuals with node positive disease should be considered in the design of clinical trials evaluating the effects of adjuvant or neoadjuvant treatment strategies, and emphasize the importance of randomized studies to assess the results of these approaches.
DOI
https://ac.els-cdn.com/S0022534701619219/1-s2.0-S0022534701619219-main.pdf?_tid=64751386-8a82-4a97-be68-c8b557ea9be9&acdnat=1538157930_a020ca506c8ee057f7a16e82e1411a0e
Volume
161
Issue
2
First Page
449
Last Page
454
Disciplines
Medicine and Health Sciences
NSUWorks Citation
Vieweg, Johannes; Gschwend, J E; Herr, H W; and Fair, W R, "Pelvic lymph node dissection can be curative in patients with node positive bladder cancer." (1999). NSU-MD Faculty Articles. 16.
https://nsuworks.nova.edu/hpd_md_facarticles/16
