Nodal Positive Urothelial Cancer of the Bladder: Extracapsular Extension of Lymph Node Metastases but Not Nodal Tumor Burden Is an Independent Adverse Risk Factor
R Seiler, M von Gunten, GN Thalmann, A Fleischmann. University Bern, Bern, Switzerland
Background: Nodal positive bladder cancer is a heterogeneous disease with a chance of cure in a subset of surgical treated patients. Identification of risk factors is highly warranted to better predict the individual clinical course. Recently the total diameter of all metastases has been presented as new prognostic factor.
Design: A cohort (n=162) of nodal positive bladder cancer patients (preoperative stage N0M0) was treated by cystectomy and standardized extended bilateral lymphadenectomy in curative intent. The prognostic impact of different tumor characteristics (diameter of all metastases, tumor and lymph node (LN) stage, number of positive nodes and extracapsular extension of LN metastases) were evaluated for recurrence-free (RFS), disease-specific (DSS) and overall (OS) survival, respectively. For independent risk factors recurrence patterns were studied.
Results: In all, 4494 LN (median 27 per patient, range: 10-56) were evaluated and 866 LN metastases (median 3 per patient, range: 1-46) were detected. The 5-year overall survival of the cohort was 33%. In univariate analysis all endpoints (RFS, DSS and OS) were significantly stratified by tumor stage (p<0.005), extracapsular extension (p<0.001), total diameter of metastases (p<0.03) and LN stage (pN1 vs. pN2; p<0.03). In multivariate analysis extracapsular extension was the strongest independent risk factor (p<0.03; hazard ratios: RFS: 1.8, DSS: 2.0, OS: 2.1), while total diameter of all metastases missed to add independent prognostic information (p>0.5). Advanced tumor stage (pT3/4 vs pT1/2) was a significant (p<0.005) predictor for distant recurrence, whereas extracapsular extension did not predict a specific recurrence pattern.
Conclusions: The most important independent risk factor in nodal positive bladder cancer is the qualitative feature ¨extracapsular extension of LN metastases¨, while the nodal tumor burden does not add independent prognostic information. This suggests important biological differences between subsets of nodal positive bladder cancers that are not adequately represented in the current TNM classification.
Category: Genitourinary (including renal tumors)
Monday, March 22, 2010 1:00 PM
Platform Session: Section A, Monday Afternoon