Clinical and Pathological Predictors for Occult Lymph Node Involvement in Patients With Clinical Node-Negative...

Area of Science:

• Urology
• Oncology
• Pathology

Background:

• Accurate staging of bladder cancer (BC) is crucial for treatment planning.
• Identifying occult lymph node metastasis in clinically node-negative (cN0) patients with BC is a significant challenge.
• Radical cystectomy with pelvic lymph node dissection (RC-PLND) is standard for staging and treatment.

Purpose of the Study:

• To evaluate predictors of pathological lymph node positivity (pN+) in patients with clinical T1-4N0M0 bladder cancer undergoing RC-PLND.
• To identify factors associated with recurrence-free survival (RFS) and overall survival (OS) in this patient cohort.

Main Methods:

• Retrospective analysis of 440 patients with cT1-4N0M0 BC undergoing RC-PLND between February 2004 and October 2020.
• Logistic regression and multivariable analysis to identify predictors of pN+ status.
• Kaplan-Meier and Cox proportional hazards models to assess RFS and OS.

Main Results:

• 17% of patients had pN+ disease. Lymphovascular invasion (LVI) on TURBT (OR 2.62), positive surgical margins (OR 16.77), and cT2 disease (OR 1.89) were associated with higher odds of pN+.
• pN+ patients had significantly higher rates of recurrence (HR 7.67) and death (HR 3.26).
• Preoperative hydronephrosis predicted worse RFS and OS; positive surgical margins and renal function predicted worse OS.

Conclusions:

• Positive surgical margins, LVI, and advanced clinical T stage (≥ cT2) are strong predictors of pN+ disease in cT1-4N0M0 BC patients.
• Preoperative factors can help identify patients at higher risk for positive lymph nodes, potentially guiding treatment decisions.
• Accurate lymph node staging is critical for predicting survival outcomes in bladder cancer.