Critical analysis of the 2010 TNM classification in patients with lymph node-positive bladder cancer

Influence of lymph node disease burden

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objectives: In 2010, a new TNM staging system was published by American Joint Committee on Cancer, changing the nodal classification to include the presence of common iliac lymph node (LN) involvement as N3 category. The objective of this study was to define the capability of the current TNM nodal classification to separate patients with different prognostic stages and to evaluate the effect of LN disease burden. Methods and materials: A total of 93 patients with metastatic LNs after radical cystectomy and extended LN dissection for urothelial carcinoma of the bladder between 1999 and 2012 were included. The median follow-up was 21.5 months. The correlation between N3 and indicators of LN disease burden was analyzed using the Spearman correlation coefficient. Recurrence-free survival (RFS) and overall survival (OS) analysis was performed using the Kaplan-Meier and Cox proportional hazards methods. Results: The presence of N3 disease was associated with higher number of metastatic LNs (7 vs. 2, P<0.01); however, this was highly variable and correlation coefficients between common iliac metastatic LNs and other lymphatic disease burden indicators demonstrated weak association (0.39-0.63). Patients with N1 lesions were found to have a distinct RFS and OS (P<0.01 and P = 0.01, respectively). A trend toward worse RFS (P = 0.07) and OS (P = 0.08) was observed in patients with N3 lesions. However, no difference in RFS or OS was found between patients with N2 and N3 lesions (P = 0.83 and 0.50, respectively). Conclusions: The N3 category in the current TNM classification defines a group of patients with high but heterogeneous disease burden. This may be the explanation for its lack of prognostic stratification when compared with N2 category bladder cancer.

Original languageEnglish
Pages (from-to)1003-1009
Number of pages7
JournalUrologic Oncology: Seminars and Original Investigations
Volume32
Issue number7
DOIs
StatePublished - Oct 1 2014

Fingerprint

Neoplasm Staging
Urinary Bladder Neoplasms
Lymph Nodes
Survival
Recurrence
Cystectomy
Lymphatic Diseases
Survival Analysis
Lymph Node Excision
Urinary Bladder
Carcinoma
Neoplasms

Keywords

  • Bladder
  • Cystectomy
  • Lymph node metastasis
  • Prognosis
  • TNM classifications
  • Urothelial carcinoma

ASJC Scopus subject areas

  • Oncology
  • Urology
  • Medicine(all)

Cite this

@article{3a0cee600d62402c9e99694082bef317,
title = "Critical analysis of the 2010 TNM classification in patients with lymph node-positive bladder cancer: Influence of lymph node disease burden",
abstract = "Objectives: In 2010, a new TNM staging system was published by American Joint Committee on Cancer, changing the nodal classification to include the presence of common iliac lymph node (LN) involvement as N3 category. The objective of this study was to define the capability of the current TNM nodal classification to separate patients with different prognostic stages and to evaluate the effect of LN disease burden. Methods and materials: A total of 93 patients with metastatic LNs after radical cystectomy and extended LN dissection for urothelial carcinoma of the bladder between 1999 and 2012 were included. The median follow-up was 21.5 months. The correlation between N3 and indicators of LN disease burden was analyzed using the Spearman correlation coefficient. Recurrence-free survival (RFS) and overall survival (OS) analysis was performed using the Kaplan-Meier and Cox proportional hazards methods. Results: The presence of N3 disease was associated with higher number of metastatic LNs (7 vs. 2, P<0.01); however, this was highly variable and correlation coefficients between common iliac metastatic LNs and other lymphatic disease burden indicators demonstrated weak association (0.39-0.63). Patients with N1 lesions were found to have a distinct RFS and OS (P<0.01 and P = 0.01, respectively). A trend toward worse RFS (P = 0.07) and OS (P = 0.08) was observed in patients with N3 lesions. However, no difference in RFS or OS was found between patients with N2 and N3 lesions (P = 0.83 and 0.50, respectively). Conclusions: The N3 category in the current TNM classification defines a group of patients with high but heterogeneous disease burden. This may be the explanation for its lack of prognostic stratification when compared with N2 category bladder cancer.",
keywords = "Bladder, Cystectomy, Lymph node metastasis, Prognosis, TNM classifications, Urothelial carcinoma",
author = "Pedrosa, {Jose A.} and Hristos Kaimakliotis and Monn, {M. Francesca} and Cary, {K. Clinton} and Timothy Masterson and Rice, {Kevin R.} and Richard Foster and Richard Bihrle and Michael Koch and Liang Cheng",
year = "2014",
month = "10",
day = "1",
doi = "10.1016/j.urolonc.2014.04.002",
language = "English",
volume = "32",
pages = "1003--1009",
journal = "Urologic Oncology",
issn = "1078-1439",
publisher = "Elsevier Inc.",
number = "7",

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TY - JOUR

T1 - Critical analysis of the 2010 TNM classification in patients with lymph node-positive bladder cancer

T2 - Influence of lymph node disease burden

AU - Pedrosa, Jose A.

AU - Kaimakliotis, Hristos

AU - Monn, M. Francesca

AU - Cary, K. Clinton

AU - Masterson, Timothy

AU - Rice, Kevin R.

AU - Foster, Richard

AU - Bihrle, Richard

AU - Koch, Michael

AU - Cheng, Liang

PY - 2014/10/1

Y1 - 2014/10/1

N2 - Objectives: In 2010, a new TNM staging system was published by American Joint Committee on Cancer, changing the nodal classification to include the presence of common iliac lymph node (LN) involvement as N3 category. The objective of this study was to define the capability of the current TNM nodal classification to separate patients with different prognostic stages and to evaluate the effect of LN disease burden. Methods and materials: A total of 93 patients with metastatic LNs after radical cystectomy and extended LN dissection for urothelial carcinoma of the bladder between 1999 and 2012 were included. The median follow-up was 21.5 months. The correlation between N3 and indicators of LN disease burden was analyzed using the Spearman correlation coefficient. Recurrence-free survival (RFS) and overall survival (OS) analysis was performed using the Kaplan-Meier and Cox proportional hazards methods. Results: The presence of N3 disease was associated with higher number of metastatic LNs (7 vs. 2, P<0.01); however, this was highly variable and correlation coefficients between common iliac metastatic LNs and other lymphatic disease burden indicators demonstrated weak association (0.39-0.63). Patients with N1 lesions were found to have a distinct RFS and OS (P<0.01 and P = 0.01, respectively). A trend toward worse RFS (P = 0.07) and OS (P = 0.08) was observed in patients with N3 lesions. However, no difference in RFS or OS was found between patients with N2 and N3 lesions (P = 0.83 and 0.50, respectively). Conclusions: The N3 category in the current TNM classification defines a group of patients with high but heterogeneous disease burden. This may be the explanation for its lack of prognostic stratification when compared with N2 category bladder cancer.

AB - Objectives: In 2010, a new TNM staging system was published by American Joint Committee on Cancer, changing the nodal classification to include the presence of common iliac lymph node (LN) involvement as N3 category. The objective of this study was to define the capability of the current TNM nodal classification to separate patients with different prognostic stages and to evaluate the effect of LN disease burden. Methods and materials: A total of 93 patients with metastatic LNs after radical cystectomy and extended LN dissection for urothelial carcinoma of the bladder between 1999 and 2012 were included. The median follow-up was 21.5 months. The correlation between N3 and indicators of LN disease burden was analyzed using the Spearman correlation coefficient. Recurrence-free survival (RFS) and overall survival (OS) analysis was performed using the Kaplan-Meier and Cox proportional hazards methods. Results: The presence of N3 disease was associated with higher number of metastatic LNs (7 vs. 2, P<0.01); however, this was highly variable and correlation coefficients between common iliac metastatic LNs and other lymphatic disease burden indicators demonstrated weak association (0.39-0.63). Patients with N1 lesions were found to have a distinct RFS and OS (P<0.01 and P = 0.01, respectively). A trend toward worse RFS (P = 0.07) and OS (P = 0.08) was observed in patients with N3 lesions. However, no difference in RFS or OS was found between patients with N2 and N3 lesions (P = 0.83 and 0.50, respectively). Conclusions: The N3 category in the current TNM classification defines a group of patients with high but heterogeneous disease burden. This may be the explanation for its lack of prognostic stratification when compared with N2 category bladder cancer.

KW - Bladder

KW - Cystectomy

KW - Lymph node metastasis

KW - Prognosis

KW - TNM classifications

KW - Urothelial carcinoma

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U2 - 10.1016/j.urolonc.2014.04.002

DO - 10.1016/j.urolonc.2014.04.002

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EP - 1009

JO - Urologic Oncology

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SN - 1078-1439

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ER -