TY - JOUR
T1 - Pathologic nodal staging score for bladder cancer
T2 - A decision tool for adjuvant therapy after radical cystectomy
AU - Shariat, Shahrokh F.
AU - Rink, Michael
AU - Ehdaie, Behfar
AU - Xylinas, Evanguelos
AU - Babjuk, Marek
AU - Merseburger, Axel S.
AU - Svatek, Robert S.
AU - Cha, Eugene K.
AU - Tagawa, Scott T.
AU - Fajkovic, Harun
AU - Novara, Giacomo
AU - Karakiewicz, Pierre I.
AU - Trinh, Quoc Dien
AU - Daneshmand, Siamak
AU - Lotan, Yair
AU - Kassouf, Wassim
AU - Fritsche, Hans Martin
AU - Chun, Felix K.
AU - Sonpavde, Guru
AU - Joual, Abdennabi
AU - Scherr, Douglas S.
AU - Gonen, Mithat
N1 - Funding Information:
Financial disclosures: Shahrokh F. Shariat certifies 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: Dr. Michael Rink is supported by The Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust and a speaker for Pfizer Pharma. S.F. Shariat is an advisory board member of Ferring Pharma. S. Daneshmand is a speaker for Endo Pharmaceuticals.
PY - 2013/2
Y1 - 2013/2
N2 - Background: Radical cystectomy (RC) with pelvic lymph node dissection (PLND) is the standard of care for high-risk non-muscle-invasive and muscle-invasive bladder cancer (BCa). Objective: To develop a model that allows quantification of the likelihood that a pathologically node-negative patient has, indeed, no positive nodes. Design, setting, and participants: We analyzed data from 4335 patients treated with RC and PLND without neoadjuvant chemotherapy at 12 international academic centers. Interventions: Patients underwent RC and PLND. Outcome measurements and statistical analysis: We estimated the sensitivity of pathologic nodal staging using a beta-binomial model and developed a pathologic (postoperative) nodal staging score (pNSS) that represents the probability that a patient is correctly staged as node negative as a function of the number of examined nodes. Results and limitations: Overall, the probability of missing a positive node decreases with the increasing number of nodes examined (52% if 3 nodes are examined, 40% if 5 are examined, and 26% if 10 are examined). The proportion of having a positive node increased proportionally with advancing pathologic T stage and lymphovascular invasion (LVI). Patients with LVI who had 25 examined nodes would have a pNSS of 80% (pT1), 88% (pT2), and 66% (pT3-T4), whereas 10 examined nodes were sufficient for pNSS exceeding 90% in patients without LVI and pT0-T2 tumors. This study is limited because of its retrospective design and multicenter nature. Conclusions: We developed a tool that estimates the likelihood of lymph node (LN) metastasis in BCa patients treated with RC by evaluating the number of examined nodes, the pathologic T stage, and LVI. The pNSS indicates the adequacy of nodal staging in LN-negative patients. This tool could help to refine clinical decision making regarding adjuvant chemotherapy, follow-up scheduling, and inclusion in clinical trials.
AB - Background: Radical cystectomy (RC) with pelvic lymph node dissection (PLND) is the standard of care for high-risk non-muscle-invasive and muscle-invasive bladder cancer (BCa). Objective: To develop a model that allows quantification of the likelihood that a pathologically node-negative patient has, indeed, no positive nodes. Design, setting, and participants: We analyzed data from 4335 patients treated with RC and PLND without neoadjuvant chemotherapy at 12 international academic centers. Interventions: Patients underwent RC and PLND. Outcome measurements and statistical analysis: We estimated the sensitivity of pathologic nodal staging using a beta-binomial model and developed a pathologic (postoperative) nodal staging score (pNSS) that represents the probability that a patient is correctly staged as node negative as a function of the number of examined nodes. Results and limitations: Overall, the probability of missing a positive node decreases with the increasing number of nodes examined (52% if 3 nodes are examined, 40% if 5 are examined, and 26% if 10 are examined). The proportion of having a positive node increased proportionally with advancing pathologic T stage and lymphovascular invasion (LVI). Patients with LVI who had 25 examined nodes would have a pNSS of 80% (pT1), 88% (pT2), and 66% (pT3-T4), whereas 10 examined nodes were sufficient for pNSS exceeding 90% in patients without LVI and pT0-T2 tumors. This study is limited because of its retrospective design and multicenter nature. Conclusions: We developed a tool that estimates the likelihood of lymph node (LN) metastasis in BCa patients treated with RC by evaluating the number of examined nodes, the pathologic T stage, and LVI. The pNSS indicates the adequacy of nodal staging in LN-negative patients. This tool could help to refine clinical decision making regarding adjuvant chemotherapy, follow-up scheduling, and inclusion in clinical trials.
KW - Adjuvant chemotherapy
KW - Bladder cancer
KW - Lymph node
KW - Lymphovascular invasion
KW - Prognosis
KW - Radical cystectomy
KW - Survival
KW - Urothelial carcinoma
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UR - http://www.scopus.com/inward/citedby.url?scp=84871920557&partnerID=8YFLogxK
U2 - 10.1016/j.eururo.2012.06.008
DO - 10.1016/j.eururo.2012.06.008
M3 - Article
C2 - 22727174
AN - SCOPUS:84871920557
SN - 0302-2838
VL - 63
SP - 371
EP - 378
JO - European urology
JF - European urology
IS - 2
ER -