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. 2019 Aug 16;19(1):77.
doi: 10.1186/s12894-019-0507-z.

The impact of perivesical lymph node metastasis on clinical outcomes of bladder cancer patients undergoing radical cystectomy

Meenal Sharma  1 , Takuro Goto  1   2 , Zhiming Yang  1 , Hiroshi Miyamoto  3   4   5
Affiliations

The impact of perivesical lymph node metastasis on clinical outcomes of bladder cancer patients undergoing radical cystectomy

Meenal Sharma et al. BMC Urol. .

Abstract

Background: Perivesical lymph nodes (PVLNs) are occasionally isolated during grossing of cystectomy specimens. However, the prognostic implications of the involvement of PVLNs in bladder cancer patients, especially those with comparisons to pN0 disease, remain poorly understood.

Methods: A retrospective review identified 115 radical cystectomy cases where PVLNs had been histologically assessed. These cases were then divided into 4 groups - Group 1 (n = 76): PVLN-negative/other pelvic lymph node (non-PVLN)-negative; Group 2 (n = 5): PVLN-positive/non-PVLN-negative; Group 3 (n = 17): PVLN-negative/non-PVLN-positive; and Group 4 (n = 17): PVLN-positive/non-PVLN-positive.

Results: pT stage at cystectomy was significantly higher in Group 3 (P = 0.013), Group 4 (P < 0.001), Groups 2 and 4 (P < 0.001), or Groups 2-4 (P < 0.001) than in Group 1. However, the number of positive PVLNs (mean: 1.8 vs. 2.1; P = 0.718) or the rate of extracapsular extension in the PVLNs (40% vs. 65%, P = 0.609) was not significantly different between Group 2 and Group 4. Kaplan-Meier analysis and log-rank test revealed significantly (P < 0.05) higher risks of disease progression (Group 3/Group 4), cancer-specific mortality (Group 2/Group 3/Group 4), and overall mortality (Group 4), compared with Group 1. Multivariate analysis further showed metastasis to both PVLN and non-PVLN (Group 4), PVLN (Groups 2 and 4), or PVLN and/or non-PVLN (Groups 2-4) as an independent prognosticator for cancer-specific mortality and overall survival. There were also insignificant (P = 0.096) and significant (P = 0.036) differences in cancer-specific survival and overall survival, respectively, between Group 3 versus Group 4, and the trend of the latter was confirmed by subset multivariate analysis (hazard ratio = 3.769; P = 0.099).

Conclusions: Worse prognosis was observed in bladder cancer patients with isolated PVLN metastasis (vs. pN0 disease especially for cancer-specific survival), PVLN metastasis with or without non-PVLN metastasis (vs. pN0 disease), and concurrent PVLN and non-PVLN metastases (vs. PVLN-negative/non-PVLN-positive disease especially for overall survival). These findings indicate the importance of thorough histopathological assessment of PVLNs in radical cystectomy specimens.

Keywords: Cancer-specific survival; Mortality; Pelvic lymph node metastasis; Progression-free survival; Staging; Urothelial carcinoma.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Progression-free survival (a), cancer-specific survival (b), or overall survival (c) in bladder cancer patients undergoing radical cystectomy and pelvic lymphadenectomy according to the status of PVLN and non-PVLN metastases (i.e. Groups 1–4). Comparisons between two groups were made by log-rank test
See this image and copyright information in PMC

References

    1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424. doi: 10.3322/caac.21492. - DOI - PubMed
    1. Antoni S, Ferley J, Soerjomataram I, Znaor A, Jemal A, Bray F. Bladder cancer incidence and mortality: a global overview and recent trends. Eur Urol. 2017;71(1):96–108. doi: 10.1016/j.eururo.2016.06.010. - DOI - PubMed
    1. Zuiverloon TCM, van Kessel KEM, Bivalacqua TJ, Boormans JL, Ecke TH, Grivas PD, et al. Recommendations for follow-up of muscle-invasive bladder cancer patients: a consensus by the international bladder cancer network. Urol Oncol. 2018;36(9):423–431. doi: 10.1016/j.urolonc.2018.01.014. - DOI - PubMed
    1. Konety BR, Joslyn SA, O’Donnell MA. Extent of pelvic lymphadenectomy and its impact on outcome in patients diagnosed with bladder cancer: analysis of data from the surveillance, epidemiology and end results program data base. J Urol. 2003;169(3):946–950. doi: 10.1097/01.ju.0000052721.61645.a3. - DOI - PubMed
    1. Herr HW, Faulkner JR, Grossman HB, Crawford ED. Surgical factors influence bladder cancer outcomes: a cooperative group report. J Clin Oncol. 2004;22(14):2781–2789. doi: 10.1200/JCO.2004.11.024. - DOI - PubMed