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Lymph node yield at radical cystectomy predicts mortality in node-negative and not node-positive patients.

Todd M Morgan1, Daniel A Barocas, David F Penson

  • 1Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA. todd.morgan@vanderbilt.edu

Urology
|July 17, 2012
PubMed
Summary

Lymph node count impacts survival in bladder cancer patients without lymph node metastases. However, for node-positive patients, count is not an independent survival predictor, suggesting it reflects other factors.

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Area of Science:

  • Urology
  • Oncology
  • Surgical Pathology

Background:

  • Controversy exists regarding lymph node count and survival after radical cystectomy for bladder cancer.
  • Previous studies often fail to account for patient and provider confounding factors.

Purpose of the Study:

  • To define the relationship between lymph node count and survival in bladder cancer patients undergoing radical cystectomy.
  • To identify and control for key confounding variables in a large population-based cohort.

Main Methods:

  • Utilized the SEER-Medicare linked database (1992-2006) for urothelial bladder carcinoma patients.
  • Performed Cox regression analyses on node-negative and node-positive cohorts, controlling for covariates like age, comorbidity, stage, grade, and surgeon volume.

Main Results:

  • Analyzed 2391 node-negative and 779 node-positive patients.
  • In node-negative patients, lower lymph node counts correlated with worse overall survival (OS) and disease-specific survival (DSS).
  • In node-positive patients, lymph node count did not independently predict OS or DSS.

Conclusions:

  • Lymph node count is associated with survival in node-negative bladder cancer patients post-cystectomy.
  • In node-positive patients, lymph node count appears to be a proxy for other prognostic factors, not an independent predictor of survival.