TY - JOUR
T1 - Clinical nodal staging scores for bladder cancer
T2 - A proposal for preoperative risk assessment
AU - Shariat, Shahrokh F.
AU - Ehdaie, Behfar
AU - Rink, Michael
AU - Cha, Eugene K.
AU - Svatek, Robert S.
AU - Chromecki, Thomas F.
AU - Fajkovic, Harun
AU - Novara, Giacomo
AU - David, Scott G.
AU - Daneshmand, Siamak
AU - Fradet, Yves
AU - Lotan, Yair
AU - Sagalowsky, Arthur I
AU - Clozel, Thomas
AU - Bastian, Patrick J.
AU - Kassouf, Wassim
AU - Fritsche, Hans Martin
AU - Burger, Maximilian
AU - Izawa, Jonathan I.
AU - Tilki, Derya
AU - Abdollah, Firas
AU - Chun, Felix K.
AU - Sonpavde, Guru
AU - Karakiewicz, Pierre I.
AU - Scherr, Douglas S.
AU - Gonen, Mithat
N1 - Funding Information:
We found that the risk of LN metastases and the number of LNs needed to be removed to ensure true node-negative status increases with advancing clinical stage. There is no one-size-fits-all for LND in patients treated with RC for bladder cancer. While all patients need an LND, a limited LND seems sufficient in patients with cTa-Tis, while an extended LND should be recommended for those with cT1 and higher stage. In patients with cT3-4, even an extended LND still misses about 20% of LN metastasis. We developed a simple cNSS to aid preoperative clinical decision making about the extent of LND in patients for whom RC for bladder cancer is planned. After validation, such a tool could help physicians decide treatment strategies prior to RC and tailor the extent of LND at RC. Author contributions : Shahrokh F. Shariat had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design : Shariat, Ehdaie, Gonen. Acquisition of data : Svatek, Novara, Lotan, Sagalowsky, Fradet, Kassouf, Fritsche, Bastian, Burger, Izawa, Tilki, Abdollah, Scherr, Shariat. Analysis and interpretation of data : Shariat, Gonen. Drafting of the manuscript : Shariat, Ehdaie, Rink, Cha. Critical revision of the manuscript for important intellectual content : Shariat, Ehdaie, Rink, Cha, Svatek, Chromecki, Fajkovic, Novara, David, Daneshmand, Fradet, Lotan, Sagalowsky, Clozel, Bastian, Kassouf, Fritsche, Burger, Izawa, Tilki, Abdollah, Chun, Sonpavde, Karakiewicz, Scherr, Gonen. Statistical analysis : Shariat, Gonen. Obtaining funding : None. Administrative, technical, or material support : None. Supervision : Gonen, Shariat. Other (specify): None. Financial disclosures : I certify that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/ affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: M. Burger has consulted and lectured for Astellas Pharma, GE Healthcare, and Photocure ASA. Funding/Support and role of the sponsor : None.
PY - 2012/2
Y1 - 2012/2
N2 - Background: Radical cystectomy (RC) with pelvic lymph node dissection (LND) is the standard of care for refractory non-muscle-invasive and muscle-invasive bladder cancer. Although consensus exists on the need for LND, its extent is still debated. Objective: To develop a model that allows preoperative determination of the minimum number of lymph nodes (LNs) needed to be removed at RC to ensure true nodal status. Design, setting, and participants: We analyzed data from 4335 patients treated with RC and pelvic LND without neoadjuvant chemotherapy at 12 academic centers located in the United States, Canada, and Europe. Measurements: We estimated the sensitivity of pathologic nodal staging using a beta-binomial model and developed clinical (preoperative) nodal staging scores (cNSS), which represent the probability that a patient has LN metastasis as a function of the number of examined nodes. Results and limitations: The probability of missing a positive LN decreased with an increasing number of nodes examined (52% if 3 nodes were examined, 40% if 5 were examined, and 26% if 10 were examined). A cNSS of 90% was achieved by examining 6 nodes for clinical Ta-Tis tumors, 9 nodes for cT1 tumors, and 25 nodes for cT2 tumors. In contrast, examination of 25 nodes provided only 77% cNSS for cT3-T4 tumors. The study is limited due to its retrospective design, its multicenter nature, and a lack of preoperative staging parameters. Conclusions: Every patient treated with RC for bladder cancer needs an LND to ensure accurate nodal staging. The minimum number of examined LNs for adequate staging depends preoperatively on the clinical T stage. Predictive tools can give a preoperative estimation of the likelihood of nodal metastasis and thereby allow tailored decision-making regarding the extent of LND at RC.
AB - Background: Radical cystectomy (RC) with pelvic lymph node dissection (LND) is the standard of care for refractory non-muscle-invasive and muscle-invasive bladder cancer. Although consensus exists on the need for LND, its extent is still debated. Objective: To develop a model that allows preoperative determination of the minimum number of lymph nodes (LNs) needed to be removed at RC to ensure true nodal status. Design, setting, and participants: We analyzed data from 4335 patients treated with RC and pelvic LND without neoadjuvant chemotherapy at 12 academic centers located in the United States, Canada, and Europe. Measurements: We estimated the sensitivity of pathologic nodal staging using a beta-binomial model and developed clinical (preoperative) nodal staging scores (cNSS), which represent the probability that a patient has LN metastasis as a function of the number of examined nodes. Results and limitations: The probability of missing a positive LN decreased with an increasing number of nodes examined (52% if 3 nodes were examined, 40% if 5 were examined, and 26% if 10 were examined). A cNSS of 90% was achieved by examining 6 nodes for clinical Ta-Tis tumors, 9 nodes for cT1 tumors, and 25 nodes for cT2 tumors. In contrast, examination of 25 nodes provided only 77% cNSS for cT3-T4 tumors. The study is limited due to its retrospective design, its multicenter nature, and a lack of preoperative staging parameters. Conclusions: Every patient treated with RC for bladder cancer needs an LND to ensure accurate nodal staging. The minimum number of examined LNs for adequate staging depends preoperatively on the clinical T stage. Predictive tools can give a preoperative estimation of the likelihood of nodal metastasis and thereby allow tailored decision-making regarding the extent of LND at RC.
KW - Bladder cancer
KW - Lymph node
KW - Prognosis
KW - Radical cystectomy
KW - Survival
KW - Urothelial carcinoma
UR - http://www.scopus.com/inward/record.url?scp=83955164206&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=83955164206&partnerID=8YFLogxK
U2 - 10.1016/j.eururo.2011.10.011
DO - 10.1016/j.eururo.2011.10.011
M3 - Article
C2 - 22033174
AN - SCOPUS:83955164206
SN - 0302-2838
VL - 61
SP - 237
EP - 242
JO - European urology
JF - European urology
IS - 2
ER -