Nodal involvement in bladder cancer cases treated with radical cystectomy: incidence and prognosis

We studied the factors that promote the incidence of nodal metastasis and characterized survival predictions in cases treated with radical cystectomy.

We retrospectively studied 418 bladder cancer cases treated with radical cystectomy and bilateral endopelvic lymphadenectomy. The incidence of nodal involvement was correlated with several patient and tumor characteristics. The number of involved nodes was also correlated with the number of retrieved nodes. Finally, survival in node positive cases was correlated with some select pathological features.

Of the 418 cases nodal involvement was reported in 110 (26.3%). The mean number of harvested nodes per patient +/- SE was 17.9 +/- 6.7. The mean number of positive nodes per involved case was 4.1 +/- 5.4. A weak correlation between the number of retrieved nodes and number of positive nodes was noted (r = 0.4). Tumor pT stage and grade, and lymphovascular invasion were independent factors promoting the incidence of nodal involvement. Three-year disease-free survival in node positive cases was 37.8% +/- 4.8%. Two factors had an independent impact on survival in node positive cases, namely pT stage and the number of positive nodes.

Tumor pT stage and grade, and lymphovascular invasion independently influence the incidence of lymph node involvement. There was a weak correlation between the number of retrieved nodes and number of positive nodes. The survival probability in pT N+ cases depended on pT stage and the number of involved nodes. A prospective study with anatomical mapping of retrieved nodes is necessary to define the optimal extent of lymphadenectomy with cystectomy.