Prognostic Relevance of the Revised pN Stages in the 7th TNM Classification for Bladder Cancer.
Achim Fleischmann, George N Thalmann, Roland Seiler. University of Bern, Switzerland; Bern, Switzerland
Background: The recently published 7th TNM staging system substantially changed the pN stages in bladder cancer. However, the prognostic relevance of the revised pN3 category (metastases in the common iliac region) is obscure.
Design: One hundred and sixty two bladder cancer patients were preoperatively staged N0M0, underwent cystectomy and standardized extended bilateral pelvic lymphadenectomy and showed lymph node metastases upon pathological examination. They were followed prospectively. The prognostic categories of the new TNM system and other risk factors (extracapsular extension of lymph node metastases, largest diameter of lymph node metastases) were evaluated in terms of survival.
Results: Median age at surgery was 67 years (range 35-89); median follow-up was 7.1 years (range 0.1-19.9); 96 patients relapsed and 115 died. A median of 27 lymph nodes (range 10-56) and 3 lymph node metastases (range 1-46) were identified per patient. Five-year recurrence-free (RFS) and overall (OS) survival of the cohort was 34% and 33%, respectively. In univariate analysis extracapsular extension of nodal metastases (RFS: p<0.001; OS: p<0.001), primary tumor stage (RFS: p<0.003; OS: p<0.004) and the revised pN stages (RFS: p<0.05; OS: p<0.02) were significantly related to survival. The three survival curves separated completely showing a significant decline from pN1 to pN2 to pN3. Largest diameter of metastasis failed to predict survival. In multivariate analyses, only extracapsular extension (RFS: p=0.04, OS: p=0.004) and primary tumor stage (RFS: p=0.01, OS: p=0.04) added independent prognostic information.
Conclusions: The discriminatory ability of the revised pN stages is high showing poorest outcome for patients with pN3 disease. However, of all tested nodal tumor parameters only extracapsular extension of lymph node metastases added independent prognostic information.
Category: Genitourinary (including renal tumors)
Monday, February 28, 2011 8:45 AM
Platform Session: Section A, Monday Morning