[The clinical study of radical cystectomy for lymph node positive bladder cancer]

The impact of pelvic lymph node dissection on the survival of patients with lymph node positive bladder cancer is controversial. We analyzed the records of the bladder cancer patients treated with radical cystectomy.

Between 1976 and 1993, 84 patients with transitional cell carcinoma of the bladder were treated with radical cystectomy at Tokyo Metropolitan Komagome General Hospital. Sixteen patients (19.0%) had pathologically proved nodal metastases. These patients' records were reviewed with regard to pathological status, and the outcome compared with negative lymph node patients. The two patients with pN3, which we could not completely undergo lymph node dissection of, were excluded from the analyses for recurrence and survival.

There were 10 males and 6 females, aged between 47 and 83 with a mean of 68.3 years. There were significant differences between the patients with positive lymph node and negative in the rate of grade 3 and the rate of infiltration of cancer to the vein and lymphatics of the bladder walls. The frequency of the patients of positive lymph node was 5.3% in pT1, 10.0% in pT2, 28.6% in pT3a, 32.0% in pT3b, 50.0% in pT4, and none in pTis, pTa and pT4is. The five-year survival rates estimated by the Kaplan-Meier method were 68.6% over all 82 patients, 75.7% for the patients with negative lymph node and 30.7% for positive. Of the patients with positive lymph node, two-year survival was 80.0% for pT2-3a, versus 0% for pT3b-4. This difference was highly significant (p < 0.01). But survival analysis for pT2-3a showed no significant difference between the lymph node negative patients and positive. The recurrence rate was 57.1% (8 of 14) in patients with positive lymph node and seven patients suffered from distant metastases. All the patients which had recurrent tumors died by bladder cancer.

Radical cystectomy with lymph node dissection can provide favorable outcome in lymph node positive patients with low stage (pT2-3a). But the patients with high stage (> or = pT3b) were poor prognosis. Most of the patients died by distant metastases.