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01-12-2012 | Original Article

Does increasing the nodal yield improve outcomes in patients without nodal metastasis at radical cystectomy?

Authors: Michael Rink, Shahrokh F. Shariat, Evanguelos Xylinas, John P. Fitzgerald, Jens Hansen, David A. Green, Ashish M. Kamat, Giacomo Novara, Siamak Daneshmand, Yves Fradet, Scott T. Tagawa, Patrick J. Bastian, Wassim Kassouf, Quoc-Dien Trinh, Pierre I. Karakiewicz, Hans-Martin Fritsche, Derya Tilki, Felix K. Chun, Bjoern G. Volkmer, Marko Babjuk, Axel S. Merseburger, Douglas S. Scherr, Yair Lotan, Robert S. Svatek

Published in: World Journal of Urology | Issue 6/2012

Abstract

Purpose

To determine whether the number of lymph nodes (LNs) examined is associated with outcomes in patients without nodal metastasis after radical cystectomy (RC).

Patients and Methods

We retrospectively analyzed data from 4,188 patients treated at 12 centers with RC and pelvic lymphadenectomy without neo-adjuvant chemotherapy for urothelial carcinoma of the bladder (UCB). Outcomes of patients without LN metastasis (n = 3,088) were examined according to the LN yield analyzed as continuous variable, tertiles, and using the cutoffs of ≥9 and ≥20.

Results

The median nodal yield was 18 (range 1–123; IQR:20). A total of 2591 (84 %) and 1445 (47 %) patients had a LN yield ≥9 and ≥20, respectively. Median follow-up was 47 months (IQR:70). In multivariable analyses that adjusted for the standard clinicopathologic factors, higher LN yield was associated with a decreased risk of disease recurrence (continuous: HR = 0.996, p = 0.05; 3rd vs 1st tertile: HR = 0.853, p = 0.048; cutoff ≥20: HR = 0.851, p = 0.032). In the subgroups of patients with muscle-invasive UCB or those with ≥9 LN removed, LN yield was not associated with outcomes (p values >0.05).

Conclusions

In this large multicenter cohort of patients with node-negative UCB, higher nodal yield improved recurrence-free survival when all patients were analyzed. Patients with a high LN yield (≥20 LN removed or 3rd tertile) had the largest benefit. The lack of prognostic significance of LN yield in patients with muscle-invasive UCB or those stratified by 9 LNs removed suggests that this effect is weak. Further prospective studies are needed to help identify preoperatively the optimal template for each patient.

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Title: Does increasing the nodal yield improve outcomes in patients without nodal metastasis at radical cystectomy?
Authors: Michael Rink
Shahrokh F. Shariat
Evanguelos Xylinas
John P. Fitzgerald
Jens Hansen
David A. Green
Ashish M. Kamat
Giacomo Novara
Siamak Daneshmand
Yves Fradet
Scott T. Tagawa
Patrick J. Bastian
Wassim Kassouf
Quoc-Dien Trinh
Pierre I. Karakiewicz
Hans-Martin Fritsche
Derya Tilki
Felix K. Chun
Bjoern G. Volkmer
Marko Babjuk
Axel S. Merseburger
Douglas S. Scherr
Yair Lotan
Robert S. Svatek
Publication date: 01-12-2012
Publisher: Springer-Verlag
Published in: World Journal of Urology / Issue 6/2012
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-012-0910-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Does increasing the nodal yield improve outcomes in patients without nodal metastasis at radical cystectomy?

Abstract

Purpose

Patients and Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Patients and Methods

Results

Conclusions

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