Multi-Center Assessment of Lymph-Node Density and Nodal-Stage to Predict Disease-Specific Survival in Patients with Bladder Cancer Treated by Radical Cystectomy.

van Gennep EJ, Claps F, Bostrom PJ, Shariat SF, Neuzillet Y, Zlotta AR, Trombetta C, Eckstein M, Mertens LS, Bussani R, Burger M, Boormans JL, Wullich B, Hartmann A, Mayr R, Pavan N, Bartoletti R, Mir MC, Pouessel D, van der Hoeven J, van der Kwast TH, Allory Y, Zuiverloon TCM, Lotan Y, van Rhijn BWG (2024)

Publication Language: English

Publication Type: Journal article

Publication year: 2024

Journal

Bladder Cancer IOS Press

Book Volume: 10

Pages Range: 119-132

Journal Issue: 2

DOI: 10.3233/BLC-230086

Abstract

BACKGROUND: Prognostic tools in pathological-node (pN) patients after radical cystectomy (RC) are needed. OBJECTIVES: To evaluate the prognostic impact of lymph node (LN)-density on disease-specific survival (DSS) in patients with bladder cancer (BC) undergoing RC with pelvic lymph node dissection. METHODS: We analyzed a multi-institutional cohort of 1169 patients treated with upfront RC for cT1-4aN0M0 urothelial BCat nine centers. LN-densitywas calculated as the ratio of the number of positive LNs×100% to the number of LNs removed. The optimal LN-density cut-off value was defined by creating a time-dependent receiver operating characteristic (ROC) curve in pN patients. Univariable and multivariable Cox' regression analyses were used to assess the effect of conventional Tumor Nodes Metastasis (TNM) nodal staging system, LN-density and other LN-related variables on DSS in the pN-positive cohort. RESULTS: Of the 1169 patients, 463 (39.6%) patients had LN-involvement. The area under the ROC curve was 0.60 and the cut-off for LN-density was set at 20%, 223 of the pN-positive patients (48.2%) had a LN-density ≥ 20%. In multivariable models, the number of LN-metastases (HR 1.03, p = 0.005) and LN-density, either as continuous (HR 1.01, p = 0.013) or as categorical variable (HR 1.37, p = 0.014), were independently associated with worse DSS, whereas pN-stage was not. CONCLUSIONS: LN-density ≥ 20% was an independent predictor of worse DSS in BC patients with LN-involvement at RC. The integration of LN-density and other LN-parameters rather than only conventional pN-stage may contribute to a more refined risk-stratification in BC patients with nodal involvement.

Authors with CRIS profile

Markus Eckstein Institute of Pathology Bernd Wullich Lehrstuhl für Urologie Arndt Hartmann Lehrstuhl für Allgemeine Pathologie und Pathologische Anatomie

Involved external institutions

Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital (NKI / NKI-AVL) NL Netherlands (NL) University of Toronto CA Canada (CA) University of Pisa / Università di Pisa (UniPi) IT Italy (IT) Institut Curie FR France (FR) University of Texas Southwestern Medical Center (UT Southwestern) US United States (USA) (US) Università degli Studi di Trieste IT Italy (IT) Reinier de Graaf Hospital NL Netherlands (NL) University Hospital of the Ribera / Hospital Universitario de la Ribera ES Spain (ES) Erasmus University Medical Center (MC) NL Netherlands (NL) Universität Regensburg DE Germany (DE)

How to cite

APA:

van Gennep, E.J., Claps, F., Bostrom, P.J., Shariat, S.F., Neuzillet, Y., Zlotta, A.R.,... van Rhijn, B.W.G. (2024). Multi-Center Assessment of Lymph-Node Density and Nodal-Stage to Predict Disease-Specific Survival in Patients with Bladder Cancer Treated by Radical Cystectomy. Bladder Cancer, 10(2), 119-132. https://doi.org/10.3233/BLC-230086

MLA:

van Gennep, Erik J., et al. "Multi-Center Assessment of Lymph-Node Density and Nodal-Stage to Predict Disease-Specific Survival in Patients with Bladder Cancer Treated by Radical Cystectomy." Bladder Cancer 10.2 (2024): 119-132.

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