Clinical Lymphadenopathy in Urothelial Cancer

A Transatlantic Collaboration on Performance of Cross-sectional Imaging and Oncologic Outcomes in Patients Treated with Radical Cystectomy Without Neoadjuvant Chemotherapy

Marco Moschini, Alessandro Morlacco, Alberto Briganti, Brian Hu, Renzo Colombo, Francesco Montorsi, Igor Frank, Siamak Daneshmand, Robert Jeffrey Karnes

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Data regarding clinical node metastases (cN+) in patients undergoing radical cystectomy (RC) are scarce. Objective: To evaluate the performance of conventional imaging in detecting cN+ and analyze the impact of cN+ on survival among patients treated with RC without neoadjuvant chemotherapy (NAC). Design, setting, and participants: Data from three independent centers of consecutive patients with bladder cancer treated with RC without NAC were analyzed. Outcome measurements and statistical analysis: cN+ was defined as pelvic nodes >8. mm or abdominal nodes >10. mm in maximum short-axis diameter as detected via preoperative computed tomography or magnetic resonance imaging. Performance characteristics were evaluated considering pN+ disease as the reference standard. Multivariable Cox regression analyses were performed for prediction of survival. Results and limitations: Overall, 196 patients (7.1%) had cN+ disease before RC and pN+ status was confirmed for 122 of them (62.2%). cN+ status in the overall population had sensitivity of 18% and specificity of 96% with a calculated area under the curve of 57%. The median follow-up was 108 mo. On multivariable analyses, cN+pN+ (hazard ratio [HR] 1.84, 95% confidence interval [CI] 1.26-2.68) and cN-pN+ (HR 2.36, 95% CI 1.90-2.92) were predictors of CSM (both . p . <. 0.001). Conversely, cN+pN- status was not associated with worse survival outcomes (p > 0.2). Conclusions: Our study confirms the poor accuracy of conventional preoperative imaging in assessing nodal disease status. cN status had no independent impact on survival when all confounders were evaluated, and potentially curative treatments should not be withheld on the basis of clinical nodal status alone. Patient summary: The accuracy of conventional imaging techniques for detection of pathologic lymph node-positive disease before radical cystectomy for bladder cancer is suboptimal. The presence of clinical lymph node positivity on preoperative imaging is not an independent predictor of oncologic outcomes, and if the node invasion is not confirmed at radical cystectomy, these patients may have good long-term outcomes. Conventional imaging techniques are suboptimal in detecting preoperative node metastases. The presence of node metastases on preoperative imaging is not a predictor of poor oncologic outcomes if the node invasion is not confirmed pathologically after surgery.

Original languageEnglish (US)
JournalEuropean Urology Focus
DOIs
StateAccepted/In press - 2016

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Cystectomy
Drug Therapy
Neoplasms
Neoplasm Metastasis
Urinary Bladder Neoplasms
Survival
Lymph Nodes
Confidence Intervals
Area Under Curve
Lymphadenopathy
Tomography
Regression Analysis
Magnetic Resonance Imaging
Sensitivity and Specificity
Population

Keywords

  • Bladder cancer
  • Clinical lymph node
  • Lymph node invasion
  • Lymph node metastases
  • Radical cystectomy

ASJC Scopus subject areas

  • Urology

Cite this

Clinical Lymphadenopathy in Urothelial Cancer : A Transatlantic Collaboration on Performance of Cross-sectional Imaging and Oncologic Outcomes in Patients Treated with Radical Cystectomy Without Neoadjuvant Chemotherapy. / Moschini, Marco; Morlacco, Alessandro; Briganti, Alberto; Hu, Brian; Colombo, Renzo; Montorsi, Francesco; Frank, Igor; Daneshmand, Siamak; Karnes, Robert Jeffrey.

In: European Urology Focus, 2016.

Research output: Contribution to journalArticle

@article{ccbb133ed40440d7b98f06c449de194e,
title = "Clinical Lymphadenopathy in Urothelial Cancer: A Transatlantic Collaboration on Performance of Cross-sectional Imaging and Oncologic Outcomes in Patients Treated with Radical Cystectomy Without Neoadjuvant Chemotherapy",
abstract = "Background: Data regarding clinical node metastases (cN+) in patients undergoing radical cystectomy (RC) are scarce. Objective: To evaluate the performance of conventional imaging in detecting cN+ and analyze the impact of cN+ on survival among patients treated with RC without neoadjuvant chemotherapy (NAC). Design, setting, and participants: Data from three independent centers of consecutive patients with bladder cancer treated with RC without NAC were analyzed. Outcome measurements and statistical analysis: cN+ was defined as pelvic nodes >8. mm or abdominal nodes >10. mm in maximum short-axis diameter as detected via preoperative computed tomography or magnetic resonance imaging. Performance characteristics were evaluated considering pN+ disease as the reference standard. Multivariable Cox regression analyses were performed for prediction of survival. Results and limitations: Overall, 196 patients (7.1{\%}) had cN+ disease before RC and pN+ status was confirmed for 122 of them (62.2{\%}). cN+ status in the overall population had sensitivity of 18{\%} and specificity of 96{\%} with a calculated area under the curve of 57{\%}. The median follow-up was 108 mo. On multivariable analyses, cN+pN+ (hazard ratio [HR] 1.84, 95{\%} confidence interval [CI] 1.26-2.68) and cN-pN+ (HR 2.36, 95{\%} CI 1.90-2.92) were predictors of CSM (both . p . <. 0.001). Conversely, cN+pN- status was not associated with worse survival outcomes (p > 0.2). Conclusions: Our study confirms the poor accuracy of conventional preoperative imaging in assessing nodal disease status. cN status had no independent impact on survival when all confounders were evaluated, and potentially curative treatments should not be withheld on the basis of clinical nodal status alone. Patient summary: The accuracy of conventional imaging techniques for detection of pathologic lymph node-positive disease before radical cystectomy for bladder cancer is suboptimal. The presence of clinical lymph node positivity on preoperative imaging is not an independent predictor of oncologic outcomes, and if the node invasion is not confirmed at radical cystectomy, these patients may have good long-term outcomes. Conventional imaging techniques are suboptimal in detecting preoperative node metastases. The presence of node metastases on preoperative imaging is not a predictor of poor oncologic outcomes if the node invasion is not confirmed pathologically after surgery.",
keywords = "Bladder cancer, Clinical lymph node, Lymph node invasion, Lymph node metastases, Radical cystectomy",
author = "Marco Moschini and Alessandro Morlacco and Alberto Briganti and Brian Hu and Renzo Colombo and Francesco Montorsi and Igor Frank and Siamak Daneshmand and Karnes, {Robert Jeffrey}",
year = "2016",
doi = "10.1016/j.euf.2016.11.005",
language = "English (US)",
journal = "European Urology Focus",
issn = "2405-4569",
publisher = "Elsevier BV",

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TY - JOUR

T1 - Clinical Lymphadenopathy in Urothelial Cancer

T2 - A Transatlantic Collaboration on Performance of Cross-sectional Imaging and Oncologic Outcomes in Patients Treated with Radical Cystectomy Without Neoadjuvant Chemotherapy

AU - Moschini, Marco

AU - Morlacco, Alessandro

AU - Briganti, Alberto

AU - Hu, Brian

AU - Colombo, Renzo

AU - Montorsi, Francesco

AU - Frank, Igor

AU - Daneshmand, Siamak

AU - Karnes, Robert Jeffrey

PY - 2016

Y1 - 2016

N2 - Background: Data regarding clinical node metastases (cN+) in patients undergoing radical cystectomy (RC) are scarce. Objective: To evaluate the performance of conventional imaging in detecting cN+ and analyze the impact of cN+ on survival among patients treated with RC without neoadjuvant chemotherapy (NAC). Design, setting, and participants: Data from three independent centers of consecutive patients with bladder cancer treated with RC without NAC were analyzed. Outcome measurements and statistical analysis: cN+ was defined as pelvic nodes >8. mm or abdominal nodes >10. mm in maximum short-axis diameter as detected via preoperative computed tomography or magnetic resonance imaging. Performance characteristics were evaluated considering pN+ disease as the reference standard. Multivariable Cox regression analyses were performed for prediction of survival. Results and limitations: Overall, 196 patients (7.1%) had cN+ disease before RC and pN+ status was confirmed for 122 of them (62.2%). cN+ status in the overall population had sensitivity of 18% and specificity of 96% with a calculated area under the curve of 57%. The median follow-up was 108 mo. On multivariable analyses, cN+pN+ (hazard ratio [HR] 1.84, 95% confidence interval [CI] 1.26-2.68) and cN-pN+ (HR 2.36, 95% CI 1.90-2.92) were predictors of CSM (both . p . <. 0.001). Conversely, cN+pN- status was not associated with worse survival outcomes (p > 0.2). Conclusions: Our study confirms the poor accuracy of conventional preoperative imaging in assessing nodal disease status. cN status had no independent impact on survival when all confounders were evaluated, and potentially curative treatments should not be withheld on the basis of clinical nodal status alone. Patient summary: The accuracy of conventional imaging techniques for detection of pathologic lymph node-positive disease before radical cystectomy for bladder cancer is suboptimal. The presence of clinical lymph node positivity on preoperative imaging is not an independent predictor of oncologic outcomes, and if the node invasion is not confirmed at radical cystectomy, these patients may have good long-term outcomes. Conventional imaging techniques are suboptimal in detecting preoperative node metastases. The presence of node metastases on preoperative imaging is not a predictor of poor oncologic outcomes if the node invasion is not confirmed pathologically after surgery.

AB - Background: Data regarding clinical node metastases (cN+) in patients undergoing radical cystectomy (RC) are scarce. Objective: To evaluate the performance of conventional imaging in detecting cN+ and analyze the impact of cN+ on survival among patients treated with RC without neoadjuvant chemotherapy (NAC). Design, setting, and participants: Data from three independent centers of consecutive patients with bladder cancer treated with RC without NAC were analyzed. Outcome measurements and statistical analysis: cN+ was defined as pelvic nodes >8. mm or abdominal nodes >10. mm in maximum short-axis diameter as detected via preoperative computed tomography or magnetic resonance imaging. Performance characteristics were evaluated considering pN+ disease as the reference standard. Multivariable Cox regression analyses were performed for prediction of survival. Results and limitations: Overall, 196 patients (7.1%) had cN+ disease before RC and pN+ status was confirmed for 122 of them (62.2%). cN+ status in the overall population had sensitivity of 18% and specificity of 96% with a calculated area under the curve of 57%. The median follow-up was 108 mo. On multivariable analyses, cN+pN+ (hazard ratio [HR] 1.84, 95% confidence interval [CI] 1.26-2.68) and cN-pN+ (HR 2.36, 95% CI 1.90-2.92) were predictors of CSM (both . p . <. 0.001). Conversely, cN+pN- status was not associated with worse survival outcomes (p > 0.2). Conclusions: Our study confirms the poor accuracy of conventional preoperative imaging in assessing nodal disease status. cN status had no independent impact on survival when all confounders were evaluated, and potentially curative treatments should not be withheld on the basis of clinical nodal status alone. Patient summary: The accuracy of conventional imaging techniques for detection of pathologic lymph node-positive disease before radical cystectomy for bladder cancer is suboptimal. The presence of clinical lymph node positivity on preoperative imaging is not an independent predictor of oncologic outcomes, and if the node invasion is not confirmed at radical cystectomy, these patients may have good long-term outcomes. Conventional imaging techniques are suboptimal in detecting preoperative node metastases. The presence of node metastases on preoperative imaging is not a predictor of poor oncologic outcomes if the node invasion is not confirmed pathologically after surgery.

KW - Bladder cancer

KW - Clinical lymph node

KW - Lymph node invasion

KW - Lymph node metastases

KW - Radical cystectomy

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U2 - 10.1016/j.euf.2016.11.005

DO - 10.1016/j.euf.2016.11.005

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SN - 2405-4569

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