Pathologic Nodal Staging Score for Bladder Cancer: A Decision Tool for Adjuvant Therapy After Radical Cystectomy |
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| Authors: | Shahrokh F Shariat Michael Rink Behfar Ehdaie Evanguelos Xylinas Marek Babjuk Axel S Merseburger Robert S Svatek Eugene K Cha Scott T Tagawa Harun Fajkovic Giacomo Novara Pierre I Karakiewicz Quoc-Dien Trinh Siamak Daneshmand Yair Lotan Wassim Kassouf Hans-Martin Fritsche Felix K Chun Guru Sonpavde Abdennabi Joual Douglas S Scherr Mithat Gonen |
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| Institution: | 1. Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA;2. University Medical Center Hamburg-Eppendorf, Hamburg, Germany;3. Cochin Hospital, APHP, Paris Descartes University, Paris, France;4. Second Faculty of Medicine, Charles University, Praha, Czech Republic;5. Medical School of Hannover, Hannover, Germany;6. University of Texas Health Science Center San Antonio, San Antonio, TX, USA;g General Hospital St. Poelten, St. Poelten, Austria;h University of Padua, Padua, Italy;i University of Montréal, Montréal, Québec, Canada;j University of Southern California, Los Angeles, CA, USA;k University of Texas Southwestern Medical Center, Dallas, TX, USA;l McGill University Health Centre, Montréal, Québec, Canada;m Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany;n Baylor College of Medicine, Houston, TX, USA;o IBN Rochel Hospital, Casablanca, Morocco;p Memorial Sloan-Kettering Cancer Center, New York, NY, USA |
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| Abstract: | BackgroundRadical cystectomy (RC) with pelvic lymph node dissection (PLND) is the standard of care for high-risk non–muscle-invasive and muscle-invasive bladder cancer (BCa).ObjectiveTo develop a model that allows quantification of the likelihood that a pathologically node-negative patient has, indeed, no positive nodes.Design, setting, and participantsWe analyzed data from 4335 patients treated with RC and PLND without neoadjuvant chemotherapy at 12 international academic centers.InterventionsPatients underwent RC and PLND.Outcome measurements and statistical analysisWe estimated the sensitivity of pathologic nodal staging using a beta-binomial model and developed a pathologic (postoperative) nodal staging score (pNSS) that represents the probability that a patient is correctly staged as node negative as a function of the number of examined nodes.Results and limitationsOverall, the probability of missing a positive node decreases with the increasing number of nodes examined (52% if 3 nodes are examined, 40% if 5 are examined, and 26% if 10 are examined). The proportion of having a positive node increased proportionally with advancing pathologic T stage and lymphovascular invasion (LVI). Patients with LVI who had 25 examined nodes would have a pNSS of 80% (pT1), 88% (pT2), and 66% (pT3–T4), whereas 10 examined nodes were sufficient for pNSS exceeding 90% in patients without LVI and pT0–T2 tumors. This study is limited because of its retrospective design and multicenter nature.ConclusionsWe developed a tool that estimates the likelihood of lymph node (LN) metastasis in BCa patients treated with RC by evaluating the number of examined nodes, the pathologic T stage, and LVI. The pNSS indicates the adequacy of nodal staging in LN-negative patients. This tool could help to refine clinical decision making regarding adjuvant chemotherapy, follow-up scheduling, and inclusion in clinical trials. |
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| Keywords: | Radical cystectomy Bladder cancer Urothelial carcinoma Lymph node Lymphovascular invasion Prognosis Survival Adjuvant chemotherapy |
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