Lymphovascular Invasion is Independently Associated With Overall Survival, Cause-Specific Survival, and Local and Distant Recurrence in Patients With Negative Lymph Nodes at Radical Cystectomy

2006 ◽  
Vol 175 (5) ◽  
pp. 1653-1654
Author(s):  
Y. Lotan ◽  
A. Gupta ◽  
S.F. Shariat ◽  
G.S. Palapattu ◽  
A. Vazina ◽  
...  
Keyword(s):  
Overall Survival ◽  
Lymph Nodes ◽  
Radical Cystectomy ◽  
Lymphovascular Invasion ◽  
Distant Recurrence ◽  
Negative Lymph Nodes ◽  
Cause Specific Survival

Oncological outcomes following radical cystectomy for urothelial carcinoma of the bladder with positive lymph nodes.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 584-584
Author(s):  
Seyedeh Sanam Ladi Seyedian ◽  
Zhoobin Bateni ◽  
Shane Pearce ◽  
Saum Ghodoussipour ◽  
Azadeh Nazami ◽  
...  
Keyword(s):  
Overall Survival ◽  
Lymph Nodes ◽  
Urothelial Carcinoma ◽  
Radical Cystectomy ◽  
Subgroup Analysis ◽  
Clinical Evidence ◽  
Multivariable Analysis ◽  
Risk Of Recurrence ◽  
Oncological Outcomes ◽  
Positive Lymph Nodes

584 Background: To determine oncological outcomes among patients who underwent radical cystectomy (RC) for urothelial carcinoma (UC) of the bladder with positive lymph nodes (LN). Methods: On a retrospective review of 4093 patients from our institutional IRB approved cystectomy database from Jan 1971 to Dec 2017, we identified 3284 patients who underwent RC for UC of the bladder. We included patients with positive LNs at the final pathology. The data was stratified into three groups based on number of positive LNs: 1, 2-9, and more than 10 positive LNs. Multivariable analysis was performed to identify prognostic factors for overall survival (OS) and recurrence-free survival (RFS). A subgroup analysis was performed to assess the oncological outcomes in cases that did not receive any chemotherapy (adjuvant or neoadjuvant). Results: 712 patients (22%) had positive LN after RC. Median age was 68 years and 76% of patients were male. 105 (15%) patients had clinical evidence of LN involvement on pre-operative imaging. Patient characteristics are provided in Table. Five-year (5-y) RFS for 1, 2-9 and 10+ positive LNs was 39%, 36% and 16%, respectively (p<0.001). 5-y OS were 45%, 33% and 14%, respectively (p<0.001). On multivariable analysis, more than 10 positive LNs pathologic tumor stage >pT2, and neoadjuvant chemotherapy were associated with increased risk of recurrence and worse overall survival after radical cystectomy. Adjuvant chemotherapy was associated with decreased risk of recurrence and better overall survival after radical cystectomy. On subgroup analysis of patients with positive LNs without peri-operative chemotherapy, 5-y RFS for 1, 2-9 and 10+ positive LNs was 25%, 32% and 5%, respectively (p<0.001). 5-y OS was 31%, 20% and 4%, respectively (p<0.001). Conclusions: Only 15% of patients with positive LNs have clinical evidence of LN involvement prior to cystectomy. Oncological outcomes after radical cystectomy are associated with the number of involved LNs. Surgery alone can be curative in 20-30% of patients with less than 10+ LN.

scholarly journals Positive relationship between number of negative lymph nodes and duration of gallbladder cancer cause-specific survival after surgery

2018 ◽  
Vol Volume 10 ◽  
pp. 6961-6969 ◽  
Author(s):  
Jin-Yong Lin ◽  
Dou-Sheng Bai ◽  
Bao-Huan Zhou ◽  
Ping Chen ◽  
Jian-Jun Qian ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Gallbladder Cancer ◽  
Positive Relationship ◽  
Negative Lymph Nodes ◽  
Cause Specific Survival

PS02.203: CHARACTERISTICS AND RISK FACTORS OF LYMPH NODE METASTASIS IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA PATIENTS WITH PREOPERATIVE COMPUTED TOMOGRAPHY-NEGATIVE LYMPH NODES

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 179-180
Author(s):  
Wei Dai ◽  
Yuanqiang Zhang ◽  
Xueming Li ◽  
Lin Peng ◽  
Yongtao Han
Keyword(s):  
Risk Factors ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Cervical Lymph Node ◽  
Lymphovascular Invasion ◽  
Node Dissection ◽  
Cervical Lymph Node Dissection ◽  
Preoperative Ct ◽  
Negative Lymph Nodes

Abstract Background Characteristics and risk factors of lymph node metastasis (LNM) in esophageal squamous cell carcinoma (ESCC) patients with preoperative computed tomography (CT)-negative lymph nodes are not well elucidated. This study aimed to identify the characteristics and risk factors of LNM in ESCC patients with preoperative CT-negative lymph nodes. Methods We conducted a retrospective analysis of consecutive ESCC patients who had preoperative CT-negative lymph nodes and received esophagectomies between August 2013 and July 2016. Lymph node with a short-axis diameter ≦10 mm on preoperative CT image was considered as CT-negative lymph node. Eligible patients included those: aged 18∼80, without neoadjuvant therapy, without other malignant tumor history, without distant metastasis, without multiple esophageal lesions, tumor locating in the thoracic esophagus, receiving McKeown esophagectomy, undergoing R0 resection, having number of lymph nodes resection≧15, pathological staging as T1a-4aN0–3. Univariate and multivariate logistic regression analyses were used to identify risk factors of LNM. Results Among 243 ESCC patients identified, 137 had LNM (56.4%). The median number of lymph nodes dissected and LNM were 24 (range 15–79) and 2 (range 1–14), respectively. The rates of LNM of the upper, middle and lower thoracic ESCC were 50.0%, 59.3% and 55.1%, respectively. The rates of LNM with the maximal short-axis diameter of lymph node on preoperative CT of ≦5 mm, 6 mm, 7 mm, 8 mm, 9 mm and 10 mm were 57.4%, 42.9%, 47.4%, 31.8%, 73.9% and 70.8%, respectively (P = 0.034). Univariate analysis showed that age (P = 0.041), maximal short-axis diameter of lymph node on CT (P = 0.034), cervical lymph node dissection (P = 0.031), lymphovascular invasion (P < 0.001) and perineural invasion (P = 0.017) were associated with LNM. Multivariate analysis revealed that cervical lymph node dissection (P = 0.018), lymphovascular invasion (P = 0.007) and perineural invasion (P = 0.025) were independent risk factors of LNM. Conclusion Our study showed that the rates of LNM were also high in ESCC patients with preoperative CT-negative lymph nodes. Standard lymph node dissection is necessary for these patients. Cervical lymph node dissection, lymphovascular invasion and perineural invasion are independent risk factors of LNM in ESCC patients with preoperative CT-negative lymph nodes. Disclosure All authors have declared no conflicts of interest.

Lymphovascular Invasion Is Independently Associated With Overall Survival, Cause-Specific Survival, and Local and Distant Recurrence in Patients With Negative Lymph Nodes at Radical Cystectomy

2005 ◽  
Vol 23 (27) ◽  
pp. 6533-6539 ◽  
Author(s):  
Yair Lotan ◽  
Amit Gupta ◽  
Shahrokh F. Shariat ◽  
Ganesh S. Palapattu ◽  
Amnon Vazina ◽  
...  
Keyword(s):  
Overall Survival ◽  
Bladder Cancer ◽  
Lymph Nodes ◽  
Lymphovascular Invasion ◽  
Cox Regression ◽  
Independent Predictor ◽  
Transitional Cell ◽  
Node Negative ◽  
Node Positive ◽  
Increased Risk

Purpose We hypothesized that bladder cancer patients with associated lymphovascular invasion (LVI) are at increased risk of occult metastases. Methods A multi-institutional group (University of Texas Southwestern [Dallas, TX], Baylor College of Medicine [Houston, TX], Johns Hopkins University [Baltimore, MD]) carried out a retrospective study of 958 patients who underwent cystectomy for bladder cancer between 1984 and 2003. Of patients with transitional-cell carcinoma (n = 776), LVI status was available for 750. LVI was defined as the presence of tumor cells within an endothelium-lined space. Results LVI was present in 36.4% (273 of 750) overall, involving 26% (151 of 581) and 72% (122 of 169) of node-negative and node-positive patients, respectively. Prevalence of LVI increased with higher pathologic stage (9.0%, 23%, 60%, and 78%, for T1, T2, T3, and T4, respectively; P < .001). Using multivariate Cox regression analyses including age, stage, grade, and number of pelvic lymph nodes removed, LVI was an independent predictor of local (HR = 2.03, P = .049), distant (HR = 2.60, P = .0011), and overall (HR = 2.02, P = .0003) recurrence in node-negative patients. LVI was an independent predictor of overall (HR = 1.84, P = .0002) and cause-specific (HR = 2.07, P = .0012) survival in node-negative patients. LVI maintained its independent predictor status in competing risks regression models (P = .013), where other-cause mortality was considered as a competing risk. LVI was not a predictor of recurrence or survival in node-positive patients. Conclusion LVI is an independent predictor of recurrence and decreased cause-specific and overall survival in patients who undergo cystectomy for invasive bladder cancer and are node-negative. These patients represent a high risk group that may benefit from integrated therapy with cystectomy and perioperative systemic chemotherapy.

Centralization of radical cystectomy for bladder cancer in a universal healthcare system: Early results from a Canadian academic center.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 516-516
Author(s):  
Jan Krzysztof Rudzinski ◽  
Niels Jacobsen ◽  
Sunita Ghosh ◽  
Scott A. North ◽  
Naveen S. Basappa ◽  
...  
Keyword(s):  
Overall Survival ◽  
Bladder Cancer ◽  
Lymph Nodes ◽  
Radical Cystectomy ◽  
Blood Product ◽  
Perioperative Outcomes ◽  
Blood Product Transfusion ◽  
Transfusion Rate ◽  
Academic Teaching ◽  
R1 Resection

516 Background: Radical cystectomy for bladder cancer is a complex surgical oncology procedure. Centralization of this procedure to high volume, fellowship-trained surgeons may improve clinical outcomes. Our objective was to compare outcomes of radical cystectomy before and after centralization of care. Methods: A retrospective analysis of data from the University of Alberta Radical Cystectomy Database was performed. Eligible subjects were those with histologically proven urothelial carcinoma of the bladder (cTanyN1-3M0) undergoing curative intent surgery. Patients were classified into pre-centralization era (1994-2007; N = 523) and post-centralization era (2013-present; N = 134) cohorts for analyses. Pre-centralization era patients were treated by 1 of 11 urologic surgeons at 2 academic teaching hospitals. Post-centralization era patients were treated by 1 of 2 fellowship-trained urologic oncologists at 1 academic teaching hospital. Outcomes were overall survival, 90-day mortality rate, positive surgical margin (R1) resection rate, total number of lymph nodes evaluated, and 90-day blood product transfusion rate. The Kaplan-Meier method and multivariable regression analyses were used to analyze survival outcomes. Statistical tests were two-sided (p≤0.05). Results: The median follow-up duration in the pre- and post-centralization era was 33 months and 16 months, respectively. The predicted 2-year overall survival rate was 62% in the pre-centralization era and 84% in the post-centralization era (Log rank P = 0.0007; multivariable HR 0.40, 95% CI 0.24 to 0.68, P < 0.0001). Treatment in the post-centralization era was associated with lower 90-day mortality (6.3% versus 1.5%, multivariable OR 0.23, 95% CI 0.06 to 0.99, P = 0.049), R1 resection (13.0% versus 1.5%; multivariable OR 0.07, 95% CI 0.01 to 0.51, P = 0.009), and 90-day blood product transfusion (59% versus 6%, P < 0.0001) as well as higher total number of lymph nodes evaluated (7 versus 30 lymph nodes, P < 0.0001). Conclusions: Surgical treatment in the post-centralization era was associated with superior survival, cancer control, and perioperative outcomes.

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