Survival Of Patients With Lymph Node Metastasis Above The Bifurcation Of The Common Iliac Vessels Treated With Surgery Only

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology
Article Date: 11 Nov 2007 - 0:00 PDT

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UroToday.com- In this article published in the October issue of the Journal of Urology, Steven and Poulsen report the 5-year cancer specific and overall survival on 336 consecutive patients with invasive bladder cancer who underwent a radical cystectomy and extended lymph node dissection that included the common iliac and peri-aortic lymph nodes up to the inferior mesenteric artery. None of the patients received neo adjuvant or adjuvant chemotherapy.

The percentage of patients with lymph node metastases was 19% (64) while 34% of these 64 patients (18% of the total patient population) had nodal involvement above the common iliac vessels. As expected, lymph node involvement of any kind had a significant impact on cancer-specific and overall survival. Patients with lymph node metastases had a 5-year cancer-specific survival of 39% compared to 76% in node negative patients. Interestingly, there was no difference in 5-year survival between patients with nodal involvement below the bifurcation of the common iliac vessels (42%), those with metastases above the bifurcation (37%), or those with any nodal involvement (41%).

The authors suggest that extended lymph node dissection is important for diagnostic and therapeutic reasons. Nodal involvement above the true pelvis (bifurcation of the common iliac vessels) is staged as metastatic (M1) disease rather than node positive disease (N+) in the current TNM staging system. The results showing surgery alone having a 5-year survival rate of 37% without chemotherapy is significantly better than historical controls of patients with M1 disease, though most of those had lung metastases. By this comparison, node dissection is therapeutic. A larger question is if retroperitoneal nodal disease should be considered metastatic (M+) or node positive (N+). In addition, only a randomized study can answer the therapeutic effect of an extended node dissection. However, this article adds to the body of literature that a more extensive node dissection in patients with muscle invasive bladder cancer is beneficial.

Steven K, Poulsen AL

J of Urol. 178(4): 1218- 1224, October 2007
doi:10.1016/j.juro.2007.05.160

Reported by UroToday.com Contributing Editor David P. Wood, M.D

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