Transitional cell carcinoma of the urinary bladder with regional lymph node involvement treated by cystectomy: Clinicopathologic features associated with outcome

Igor Frank, John C. Cheville, Michael L. Blute, Christine M. Lohse, Ajay Nehra, Amy L. Weaver, Robert Jeffrey Karnes, Horst Zincke

Research output: Contribution to journalArticle

68 Citations (Scopus)

Abstract

BACKGROUND. Patients with transitional cell carcinoma (TCC) of the urinary bladder metastatic to regional lymph nodes (LN) typically have a poor prognosis. However, some patients are cured by radical cystectomy alone. The goal of this study was to identify predictors of survival in this cohort. METHODS. The authors identified 154 patients with TCC metastatic to regional LNs treated by cystectomy between 1970 and 1998. Clinical characteristics collected included age, gender, and preoperative computed tomographic or magnetic resonance image scan findings, as well as neoadjuvant and adjuvant therapy. Pathologic features evaluated included multifocality, size, pathologic stage, grade, and margin status of the primary tumor, as well as the number, location, and bilaterality of the positive LNs. Capsular penetration, greatest linear extent, and surface area of the largest metastatic LN deposit were also recorded. The Kaplan-Meier method was used to evaluate survival rates. Cox proportional hazards models were used to identify predictors of outcome. RESULTS. The mean follow-up was 4.5 years (range, 0.1-13.9 years). In a multivariate setting, only adjuvant chemotherapy and the number of positive LNs were associated significantly with death from TCC. Patients treated adjuvantly with chemotherapy were 2.1 times less likely to die of their disease (P = 0.005). Each increase in one positive LN increased the risk of death from TCC by 20% (P < 0.001). Recursive partitioning indicated that the optimal cutoff point to predict death from TCC was five or more positive LNs. CONCLUSIONS. Adjuvant chemotherapy and the number of positive LNs were associated significantly with death from TCC.

Original languageEnglish (US)
Pages (from-to)2425-2431
Number of pages7
JournalCancer
Volume97
Issue number10
DOIs
StatePublished - May 15 2003

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Transitional Cell Carcinoma
Cystectomy
Urinary Bladder
Lymph Nodes
Adjuvant Chemotherapy
Neoadjuvant Therapy
Proportional Hazards Models
Magnetic Resonance Spectroscopy
Survival Rate
Drug Therapy
Survival
Neoplasms

Keywords

  • Outcome prediction
  • Regional lymph nodes
  • Staging
  • Transitional cell carcinoma
  • Urinary bladder

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Transitional cell carcinoma of the urinary bladder with regional lymph node involvement treated by cystectomy : Clinicopathologic features associated with outcome. / Frank, Igor; Cheville, John C.; Blute, Michael L.; Lohse, Christine M.; Nehra, Ajay; Weaver, Amy L.; Karnes, Robert Jeffrey; Zincke, Horst.

In: Cancer, Vol. 97, No. 10, 15.05.2003, p. 2425-2431.

Research output: Contribution to journalArticle

Frank, Igor ; Cheville, John C. ; Blute, Michael L. ; Lohse, Christine M. ; Nehra, Ajay ; Weaver, Amy L. ; Karnes, Robert Jeffrey ; Zincke, Horst. / Transitional cell carcinoma of the urinary bladder with regional lymph node involvement treated by cystectomy : Clinicopathologic features associated with outcome. In: Cancer. 2003 ; Vol. 97, No. 10. pp. 2425-2431.
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abstract = "BACKGROUND. Patients with transitional cell carcinoma (TCC) of the urinary bladder metastatic to regional lymph nodes (LN) typically have a poor prognosis. However, some patients are cured by radical cystectomy alone. The goal of this study was to identify predictors of survival in this cohort. METHODS. The authors identified 154 patients with TCC metastatic to regional LNs treated by cystectomy between 1970 and 1998. Clinical characteristics collected included age, gender, and preoperative computed tomographic or magnetic resonance image scan findings, as well as neoadjuvant and adjuvant therapy. Pathologic features evaluated included multifocality, size, pathologic stage, grade, and margin status of the primary tumor, as well as the number, location, and bilaterality of the positive LNs. Capsular penetration, greatest linear extent, and surface area of the largest metastatic LN deposit were also recorded. The Kaplan-Meier method was used to evaluate survival rates. Cox proportional hazards models were used to identify predictors of outcome. RESULTS. The mean follow-up was 4.5 years (range, 0.1-13.9 years). In a multivariate setting, only adjuvant chemotherapy and the number of positive LNs were associated significantly with death from TCC. Patients treated adjuvantly with chemotherapy were 2.1 times less likely to die of their disease (P = 0.005). Each increase in one positive LN increased the risk of death from TCC by 20{\%} (P < 0.001). Recursive partitioning indicated that the optimal cutoff point to predict death from TCC was five or more positive LNs. CONCLUSIONS. Adjuvant chemotherapy and the number of positive LNs were associated significantly with death from TCC.",
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T2 - Clinicopathologic features associated with outcome

AU - Frank, Igor

AU - Cheville, John C.

AU - Blute, Michael L.

AU - Lohse, Christine M.

AU - Nehra, Ajay

AU - Weaver, Amy L.

AU - Karnes, Robert Jeffrey

AU - Zincke, Horst

PY - 2003/5/15

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N2 - BACKGROUND. Patients with transitional cell carcinoma (TCC) of the urinary bladder metastatic to regional lymph nodes (LN) typically have a poor prognosis. However, some patients are cured by radical cystectomy alone. The goal of this study was to identify predictors of survival in this cohort. METHODS. The authors identified 154 patients with TCC metastatic to regional LNs treated by cystectomy between 1970 and 1998. Clinical characteristics collected included age, gender, and preoperative computed tomographic or magnetic resonance image scan findings, as well as neoadjuvant and adjuvant therapy. Pathologic features evaluated included multifocality, size, pathologic stage, grade, and margin status of the primary tumor, as well as the number, location, and bilaterality of the positive LNs. Capsular penetration, greatest linear extent, and surface area of the largest metastatic LN deposit were also recorded. The Kaplan-Meier method was used to evaluate survival rates. Cox proportional hazards models were used to identify predictors of outcome. RESULTS. The mean follow-up was 4.5 years (range, 0.1-13.9 years). In a multivariate setting, only adjuvant chemotherapy and the number of positive LNs were associated significantly with death from TCC. Patients treated adjuvantly with chemotherapy were 2.1 times less likely to die of their disease (P = 0.005). Each increase in one positive LN increased the risk of death from TCC by 20% (P < 0.001). Recursive partitioning indicated that the optimal cutoff point to predict death from TCC was five or more positive LNs. CONCLUSIONS. Adjuvant chemotherapy and the number of positive LNs were associated significantly with death from TCC.

AB - BACKGROUND. Patients with transitional cell carcinoma (TCC) of the urinary bladder metastatic to regional lymph nodes (LN) typically have a poor prognosis. However, some patients are cured by radical cystectomy alone. The goal of this study was to identify predictors of survival in this cohort. METHODS. The authors identified 154 patients with TCC metastatic to regional LNs treated by cystectomy between 1970 and 1998. Clinical characteristics collected included age, gender, and preoperative computed tomographic or magnetic resonance image scan findings, as well as neoadjuvant and adjuvant therapy. Pathologic features evaluated included multifocality, size, pathologic stage, grade, and margin status of the primary tumor, as well as the number, location, and bilaterality of the positive LNs. Capsular penetration, greatest linear extent, and surface area of the largest metastatic LN deposit were also recorded. The Kaplan-Meier method was used to evaluate survival rates. Cox proportional hazards models were used to identify predictors of outcome. RESULTS. The mean follow-up was 4.5 years (range, 0.1-13.9 years). In a multivariate setting, only adjuvant chemotherapy and the number of positive LNs were associated significantly with death from TCC. Patients treated adjuvantly with chemotherapy were 2.1 times less likely to die of their disease (P = 0.005). Each increase in one positive LN increased the risk of death from TCC by 20% (P < 0.001). Recursive partitioning indicated that the optimal cutoff point to predict death from TCC was five or more positive LNs. CONCLUSIONS. Adjuvant chemotherapy and the number of positive LNs were associated significantly with death from TCC.

KW - Outcome prediction

KW - Regional lymph nodes

KW - Staging

KW - Transitional cell carcinoma

KW - Urinary bladder

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