[Transitional infiltrating carcinoma of the bladder significant in its spread to regional lymph nodes]

We analyzed the course of 170 patients, 136 of whom underwent bilateral lymphadenectomy. Data was obtained to define N of the TNM classification in 126 patients. The remaining patients (10 whose pathologic work-up was unavailable; 32 who did not undergo lymphadenectomy) were classified as Nx. Metastasis was diagnosed during follow-up in 60% of those with positive lymph nodes. In our view, metastasis was already present in these patients prior to the surgical procedure. The survival rate is significantly higher for the patient group without lymphatic spread compared to the group with negative lymph nodes and Nx. Evaluation of the patient group without lymphatic spread revealed a higher survivorship for those who received 2,000 rads (24%) prior to cystectomy compared to those who received 4,500 rads (17%) and those who received no irradiation (12%). However, there is a lower incidence of metastasis for the patient group submitted to surgery alone (50%) compared to those that received preoperative radiotherapy (73% and 67% for those treated with 2,000 and 4,500 rads, respectively). Furthermore, preoperative radiotherapy did not reduce the mortality rate which was 83% for those who received no radiotherapy, 73% for those who received 2,000 rads, and 75% for those who received 4,500 rads. However, it may seem contradictory that a radiation dose of 2,000 rads appears to be more effective in these patients than a dose of 4,500 rads which is theoretically closer to the ideal dose for treatment of node involvement. Patients with positive lymph nodes must be treated with chemotherapy as soon as they have recovered from the surgical procedure since 3 out of 5 patients have undetected micrometastases.