Three-tiered nodal classification system for bladder cancer: A new proposal

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Aim: To evaluate a three-tiered prognostic stratification using one, two to five and >five positive lymph nodes (LNs) and this nodal staging system performs across different pelvic LN dissection (PLND) templates and adjuvant chemotherapy status. Methods: We evaluated 244 patients with positive LN urothelial cancer who underwent radical cystectomy and PLND between 2000 and 2011. Survival analyses utilizing the Kaplan-Meier method and log rank test were performed. Median follow-up was 55.3 months (range: 0.4-141). Multivariable Cox proportional hazards models were built to evaluate the prognostic stratification. Results: Extended PLND template was performed on 152 (62.3%) patients and standard on 92 (37.7%). The median number of LNs resected was 14 in the standard group vs 22 in the extended group (p < 0.01) and positive LNs was 2 vs 3 (p = 0.09), respectively. Stratification in patients with: one positive LN, two to five positive LNs or >five positive LNs lead to 5-year recurrence-free survival of: 48.6, 34.5 and 15.9% for each group, while the 5-year overall survival was: 43.0, 22.1 and 11.3%, respectively. Stratification in the three groups was also verified irrespective of PLND template and adjuvant chemotherapy. Two multivariable models confirmed the findings when controlling for demographic features and known pathologic risk factors. Conclusion: Three-tiered nodal classification system using the number of metastatic LNs (one, two to five and >five) stratifies patients with lymphatic disease into distinct prognostic groups.

Original languageEnglish
Pages (from-to)399-408
Number of pages10
JournalFuture Oncology
Volume11
Issue number3
DOIs
StatePublished - Feb 1 2015

Fingerprint

Urinary Bladder Neoplasms
Lymph Nodes
Dissection
Adjuvant Chemotherapy
Survival
Cystectomy
Lymphatic Diseases
Survival Analysis
Lymph Node Excision
Proportional Hazards Models
Demography
Recurrence
Neoplasms

Keywords

  • adjuvant chemotherapy
  • cystectomy
  • lymph node dissection
  • neoadjuvant chemotherapy
  • nodal metastasis
  • prognosis
  • survival outcome
  • TNM classifications
  • urinary bladder
  • urothelial carcinoma

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Three-tiered nodal classification system for bladder cancer : A new proposal. / Pedrosa, Jose A.; Koch, Michael; Kaimakliotis, Hristos; Monn, M. Francesca; Masterson, Timothy; Rice, Kevin R.; Cary, K. Clinton; Foster, Richard; Bihrle, Richard; Cheng, Liang.

In: Future Oncology, Vol. 11, No. 3, 01.02.2015, p. 399-408.

Research output: Contribution to journalArticle

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abstract = "Aim: To evaluate a three-tiered prognostic stratification using one, two to five and >five positive lymph nodes (LNs) and this nodal staging system performs across different pelvic LN dissection (PLND) templates and adjuvant chemotherapy status. Methods: We evaluated 244 patients with positive LN urothelial cancer who underwent radical cystectomy and PLND between 2000 and 2011. Survival analyses utilizing the Kaplan-Meier method and log rank test were performed. Median follow-up was 55.3 months (range: 0.4-141). Multivariable Cox proportional hazards models were built to evaluate the prognostic stratification. Results: Extended PLND template was performed on 152 (62.3{\%}) patients and standard on 92 (37.7{\%}). The median number of LNs resected was 14 in the standard group vs 22 in the extended group (p < 0.01) and positive LNs was 2 vs 3 (p = 0.09), respectively. Stratification in patients with: one positive LN, two to five positive LNs or >five positive LNs lead to 5-year recurrence-free survival of: 48.6, 34.5 and 15.9{\%} for each group, while the 5-year overall survival was: 43.0, 22.1 and 11.3{\%}, respectively. Stratification in the three groups was also verified irrespective of PLND template and adjuvant chemotherapy. Two multivariable models confirmed the findings when controlling for demographic features and known pathologic risk factors. Conclusion: Three-tiered nodal classification system using the number of metastatic LNs (one, two to five and >five) stratifies patients with lymphatic disease into distinct prognostic groups.",
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author = "Pedrosa, {Jose A.} and Michael Koch and Hristos Kaimakliotis and Monn, {M. Francesca} and Timothy Masterson and Rice, {Kevin R.} and Cary, {K. Clinton} and Richard Foster and Richard Bihrle and Liang Cheng",
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T1 - Three-tiered nodal classification system for bladder cancer

T2 - A new proposal

AU - Pedrosa, Jose A.

AU - Koch, Michael

AU - Kaimakliotis, Hristos

AU - Monn, M. Francesca

AU - Masterson, Timothy

AU - Rice, Kevin R.

AU - Cary, K. Clinton

AU - Foster, Richard

AU - Bihrle, Richard

AU - Cheng, Liang

PY - 2015/2/1

Y1 - 2015/2/1

N2 - Aim: To evaluate a three-tiered prognostic stratification using one, two to five and >five positive lymph nodes (LNs) and this nodal staging system performs across different pelvic LN dissection (PLND) templates and adjuvant chemotherapy status. Methods: We evaluated 244 patients with positive LN urothelial cancer who underwent radical cystectomy and PLND between 2000 and 2011. Survival analyses utilizing the Kaplan-Meier method and log rank test were performed. Median follow-up was 55.3 months (range: 0.4-141). Multivariable Cox proportional hazards models were built to evaluate the prognostic stratification. Results: Extended PLND template was performed on 152 (62.3%) patients and standard on 92 (37.7%). The median number of LNs resected was 14 in the standard group vs 22 in the extended group (p < 0.01) and positive LNs was 2 vs 3 (p = 0.09), respectively. Stratification in patients with: one positive LN, two to five positive LNs or >five positive LNs lead to 5-year recurrence-free survival of: 48.6, 34.5 and 15.9% for each group, while the 5-year overall survival was: 43.0, 22.1 and 11.3%, respectively. Stratification in the three groups was also verified irrespective of PLND template and adjuvant chemotherapy. Two multivariable models confirmed the findings when controlling for demographic features and known pathologic risk factors. Conclusion: Three-tiered nodal classification system using the number of metastatic LNs (one, two to five and >five) stratifies patients with lymphatic disease into distinct prognostic groups.

AB - Aim: To evaluate a three-tiered prognostic stratification using one, two to five and >five positive lymph nodes (LNs) and this nodal staging system performs across different pelvic LN dissection (PLND) templates and adjuvant chemotherapy status. Methods: We evaluated 244 patients with positive LN urothelial cancer who underwent radical cystectomy and PLND between 2000 and 2011. Survival analyses utilizing the Kaplan-Meier method and log rank test were performed. Median follow-up was 55.3 months (range: 0.4-141). Multivariable Cox proportional hazards models were built to evaluate the prognostic stratification. Results: Extended PLND template was performed on 152 (62.3%) patients and standard on 92 (37.7%). The median number of LNs resected was 14 in the standard group vs 22 in the extended group (p < 0.01) and positive LNs was 2 vs 3 (p = 0.09), respectively. Stratification in patients with: one positive LN, two to five positive LNs or >five positive LNs lead to 5-year recurrence-free survival of: 48.6, 34.5 and 15.9% for each group, while the 5-year overall survival was: 43.0, 22.1 and 11.3%, respectively. Stratification in the three groups was also verified irrespective of PLND template and adjuvant chemotherapy. Two multivariable models confirmed the findings when controlling for demographic features and known pathologic risk factors. Conclusion: Three-tiered nodal classification system using the number of metastatic LNs (one, two to five and >five) stratifies patients with lymphatic disease into distinct prognostic groups.

KW - adjuvant chemotherapy

KW - cystectomy

KW - lymph node dissection

KW - neoadjuvant chemotherapy

KW - nodal metastasis

KW - prognosis

KW - survival outcome

KW - TNM classifications

KW - urinary bladder

KW - urothelial carcinoma

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