Document Detail

Pathologic nodal staging score for bladder cancer: a decision tool for adjuvant therapy after radical cystectomy.
MedLine Citation:
PMID:  22727174     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Radical 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).
OBJECTIVE: To develop a model that allows quantification of the likelihood that a pathologically node-negative patient has, indeed, no positive nodes.
DESIGN, SETTING, AND PARTICIPANTS: We analyzed data from 4335 patients treated with RC and PLND without neoadjuvant chemotherapy at 12 international academic centers.
INTERVENTIONS: Patients underwent RC and PLND.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We 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 LIMITATIONS: Overall, 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.
CONCLUSIONS: We 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.
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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Publication Detail:
Type:  Journal Article; Multicenter Study     Date:  2012-06-16
Journal Detail:
Title:  European urology     Volume:  63     ISSN:  1873-7560     ISO Abbreviation:  Eur. Urol.     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2012-12-31     Completed Date:  2013-07-08     Revised Date:  2013-11-06    
Medline Journal Info:
Nlm Unique ID:  7512719     Medline TA:  Eur Urol     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  371-8     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA.
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MeSH Terms
Aged, 80 and over
Carcinoma / drug therapy,  pathology*,  surgery
Chemotherapy, Adjuvant / methods
Cohort Studies
Cystectomy* / methods
Decision Support Techniques*
Likelihood Functions
Lymph Node Excision* / methods
Lymph Nodes / pathology*,  surgery
Lymphatic Metastasis
Middle Aged
Neoplasm Staging
Retrospective Studies
Urinary Bladder Neoplasms / drug therapy,  pathology*,  surgery
Young Adult

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