1847 USE OF PERIOPERATIVE CHEMOTHERAPY IN PATIENTS TREATED WITH RADICAL CYSTECTOMY AND EXTENDED LYMPH NODE DISSECTION FOR UROTHELIAL CARCINOMA OF THE BLADDER AND THE EFFECT IN DOWNSTAGING AND SURVIVAL

Radical cystectomy/cystoprostatectomy with pelvic lymph node dissection (with or without neoadjuvant chemotherapy) is the gold standard in the management of patients with urothelial carcinoma (UCa) with muscularis propria (detrusor muscle) invasion. However, it remains controversial how extensive the lymph node dissection should be. In this article, we analyzed the clinicopathologic findings in patients who had radical cystectomy/cystoprostatectomy with extended versus standard lymph node dissection. A search was made through our Urologic Pathology files for radical cystectomy/cystoprostatectomy cases with extended and standard lymph node dissection for UCa. A total of 264 cases were included in the study (218 cystoprostatectomy and 46 cystectomy specimens). Mean patients age was 68 years (range = 32-92 years). Patients in all stage categories had more extended lymph node dissection performed compared with standard lymph node dissection: pT0 (20 vs 7), pTis (40 vs 12), pTa (8 vs 4), pT1 (27 vs 5), pT2 (39 vs 8), pT3 (51 vs 17), and pT4 (18 vs 8). In cases with neoadjuvant therapy there was a 19% lymph node positivity rate compared with a 24% positivity rate in those with no presurgical therapy. The only cases categorized as pT2 and below with positive lymph node metastasis were those that had extended lymph node dissection performed. Positive lymph nodes were more frequently detected in cases that had extended lymph node dissection. More than 35% of the positive lymph nodes were in nonregional distribution. Extended lymph node dissection should be considered in patients with UCa even in the low stage or post-neoadjuvant chemotherapy setting.

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More Extensive Lymph Node Dissection Improves Survival Benefit of Radical Cystectomy in Metastatic Urothelial Carcinoma of the Bladder

Clinical Genitourinary Cancer ◽

10.1016/j.clgc.2018.11.003 ◽

2019 ◽

Vol 17 (2) ◽

pp. 105-113.e2 ◽

Cited By ~ 6

Author(s):

Elio Mazzone ◽

Felix Preisser ◽

Sebastiano Nazzani ◽

Zhe Tian ◽

Nicola Fossati ◽

...

Keyword(s):

Lymph Node ◽

Urothelial Carcinoma ◽

Radical Cystectomy ◽

Lymph Node Dissection ◽

Survival Benefit ◽

Node Dissection ◽

Extensive Lymph Node Dissection ◽

Metastatic Urothelial Carcinoma ◽

Carcinoma Of The Bladder ◽

Extensive Lymph Node

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Extensive lymph node dissection in the era of increasing perioperative chemotherapy for muscle-invasive urothelial carcinoma of the bladder.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e15018 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e15018-e15018

Author(s):

Dara Denise Holder ◽

James Lin ◽

Micheal Whalen ◽

James M. McKiernan ◽

Guarionex DeCastro

Keyword(s):

Lymph Node ◽

Urothelial Carcinoma ◽

Lymph Node Dissection ◽

Perioperative Chemotherapy ◽

Node Dissection ◽

Risk Of Death ◽

Kaplan Meier ◽

Nodal Yield ◽

Carcinoma Of The Bladder ◽

Muscle Invasive

e15018 Background: The efficacy of perioperative chemotherapy (CHT) in the management of muscle invasive urothelial carcinoma of the bladder (UCB) has been attributed to its ability to eliminate occult disease, which when coupled with a cystectomy can reduce recurrence. The therapeutic role of lymphadenctomy (LND), with an appropriate template and nodal yield, during radical cystectomy (RC) is well established. To date, there have been no studies examining the integrative effect of an extended LND and the use of perioperative CHT for patients with muscle-invasive UCB. As such we examined the interaction between survival and extent of LND based on whether patients received perioperative CHT or RC only. Methods: Review of our urologic oncology database yielded 314 patients with cT2-4N0M0 UCB who underwent RC with and without perioperative CHT between 1990- 2011. Extended lymph node dissection was defined as the removal of ≥11 nodes. Clinical and pathological variables were analyzed using Cox Hazard and Kaplan Meier models. The primary endpoints examined were overall (OS) and disease-specific (DSS) survival. Results: Two hundred and four (65%) patients were identified who underwent RC only, while 110 (35%) patients received perioperative CHT and RC. There was no significant difference between the 2 groups in common demographic and pathologic variables. Fifty-one percent of patients who underwent CHT and RC and 42% who underwent a RC only had an extensive LND (p=0.16), with a mean nodal yield of 9. Extended LND was associated with a non-significant decreased risk of death in the RC-only group (HR=0.54, CI: 0.23-1.20, p=0.14), and a non-significant increase in patients who underwent perioperative CHT (HR=1.25, CI: 0.71-2.81, p=0.56). Kaplan Meier analysis showed an increase in the probability of DSS at 2 years in the RC-only group who underwent an extended LND vs. a standard LND (0.96 vs. 0.84, p= 0.12) while no such trend was observed in the perioperative CHT patients (0.75 vs. 0.75, p=0.35). Conclusions: Surgical management of occult micrometastatic disease through extended LND improves survival in patients undergoing RC only, but offers no additional benefit over perioperative CHT.

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Bladder preserving approach for liposarcomatoid variant of transitional urothelial carcinoma

Canadian Urological Association Journal ◽

10.5489/cuaj.3167 ◽

2015 ◽

Vol 9 (11-12) ◽

pp. 886

Author(s):

Shrawan K Singh ◽

Ankur Mittal ◽

Abhinandan Mukhopadhyay ◽

Nandita Kakkar ◽

Debajyoti Chatterjee

Keyword(s):

Lymph Node ◽

Urothelial Carcinoma ◽

Lymph Node Dissection ◽

Transurethral Resection ◽

Rare Case ◽

Pelvic Lymph Node Dissection ◽

Node Dissection ◽

Carcinoma Of The Bladder ◽

Worse Prognosis ◽

Bladder Tumours

Urothelial carcinoma of the bladder with variant histologies is usually underdiagnosed and understaged. It is found in <25% of cases during transurethral resection of bladder tumours. The majority of cases carry worse prognosis, with higher rates of recurrence and progression, and should be managed agressively. Here, we report a rare case of liposarcomatoid variant of urothelial carcinoma managed by partial cystectomy and standard pelvic lymph node dissection

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