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, R. Jeffrey Karnes, Horst Zincke

Research output: Contribution to journalArticle

68 Scopus citations


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
Issue number10
StatePublished - May 15 2003



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

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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