REGIONAL LYMPH NODE STATUS IN PATIENTS WITH BLADDER CANCER FOUND TO BE PATHOLOGICAL STAGE T0 AT RADICAL CYSTECTOMY FOLLOWING SYSTEMIC CHEMOTHERAPY

Introduction: Radical cystectomy (RC) is the main treatment option for patients with muscle-invasive bladder cancer (MIBC) and non-muscle-invasive bladder cancer (NMIBC), which carry the highest risk of progression. In this study, we investigated the effect of time from transurethral resection of the bladder (TUR-B) to cystectomy on lymph node positivity, cancer-specific survival and overall survival in patients with MIBC. Methods: The records were reviewed of 530 consecutive patients who had RC and pelvic lymphadenectomy procedures with curative intent performed by selected surgeons between May 2005 and April 2016. Our analysis included only patients with transitional cell carcinoma of the bladder; we excluded 23 patients with other types of tumor histology. Results: Patients who underwent delayed RC were compared with patients who were treated with early RC; both groups were similar in terms of age, gender, T stage, tumor grade, tumor differentiation, lymph node status and metastasis status. However, when both groups were compared for disease-free survival and overall survival, patients of the early-RC group had a greater advantage. Conclusions: The optimal time between the last TUR-B and RC is still controversial. A reasonable time for preoperative preparation can be allowed, but long delays, especially those exceeding 3 months, can lead to unfavorable outcomes in cancer control.

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The value of tumor marker and cytokine analysis for the assessment of regional lymph node status in cervical cancer patients

International Journal of Gynecological Cancer ◽

10.1111/j.1525-1438.2007.01176.x ◽

2008 ◽

Vol 18 (6) ◽

pp. 1279-1284 ◽

Cited By ~ 11

Author(s):

B. Kotowicz ◽

M. Fuksiewicz ◽

M. Kowalska ◽

J. Jonska-Gmyrek ◽

M. Bidzinski ◽

...

Keyword(s):

Cervical Cancer ◽

Lymph Node ◽

Lymph Node Metastases ◽

Regional Lymph Node ◽

Serum Levels ◽

Lymph Node Involvement ◽

Lymph Node Status ◽

Node Status ◽

Node Involvement ◽

Node Metastases

The aim of the study was to evaluate the utility of the measurements of the circulating tumor markers, squamous cell carcinoma antigen (SCCA), CA125, carcinoembryonic antigen (CEA), cytokeratin fragment 19 (CYFRA 21.1), and the cytokines, interleukin-6 and vascular endothelial growth factor (VEGF), to estimate regional lymph node involvement in patients with cervical cancer. The study comprised 182 untreated patients with cervical cancer. The regional lymph node status was assessed either by the postsurgical histopathologic examination or by the computed tomography (CT). Concentrations of SCCA, CEA, and CA125 were determined using the Abbott Instruments system, of CYFRA 21.1 by the Roche kits, and of IL-6 and VEGF by the ELISA of R&D Systems (Minneapolis, MN). For the statistical analyses, Mann–Whitney U test and χ2 test were applied. Serum levels of SCCA, CEA, CA125, CYFRA 21.1, IL-6, and VEGF were measured in patients with specified pelvic and para-aortic lymph node status. SCCA, CA125, and IL-6 levels were found to be significantly higher in patients with lymph node metastases than in those with no lymph node involvement. Also, the percentage of patients with simultaneously elevated concentrations of SCCA and CA125 or SCCA and IL-6 differed depending on the lymph node status and was significantly higher in the series of patients with lymph node metastases. Simultaneous assessment of serum levels of SCCA and CA125 or SCCA and IL-6 in patients with cervical cancer may be useful for the regional lymph node evaluation, especially in patients with advanced stages, when the lymph nodes are examined only by CT, with no histologic confirmation.

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p53, p21, pRB, and p16 Expression Predict Clinical Outcome in Cystectomy With Bladder Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2004.03.118 ◽

2004 ◽

Vol 22 (6) ◽

pp. 1014-1024 ◽

Cited By ~ 220

Author(s):

Shahrokh F. Shariat ◽

Hideo Tokunaga ◽

JainHua Zhou ◽

JaHong Kim ◽

Gustavo E. Ayala ◽

...

Keyword(s):

Bladder Cancer ◽

Lymph Node ◽

Radical Cystectomy ◽

Cancer Progression ◽

Lymph Node Metastases ◽

Lymph Node Status ◽

Altered Expression ◽

Pathologic Features ◽

Node Metastases ◽

P16 Expression

Purpose To determine whether p53, p21, pRB, and/or p16 expression is associated with bladder cancer stage, progression, and prognosis. Patients and Methods Immunohistochemical staining for p53, p21, pRB, and p16 was carried out on serial sections from archival specimens of 80 patients who underwent bilateral pelvic lymphadenectomy and radical cystectomy for bladder cancer (median follow-up, 101 months). Results p53, p21, and pRB or p16 expression was altered in 45 (56%), 39 (49%), and 43 (54%) tumors, respectively. Sixty-six patients (83%) had at least one marker altered, and 21 patients (26%) had all three altered. Abnormal expressions of p53, p21, and pRB/p16 expression were associated with muscle-invasive disease (P = .007, P = .003, and P = .003, respectively). The alteration of each marker was independently associated with disease progression (P ≤ .038) and disease-specific survival (P ≤ .039). In multivariable models that included standard pathologic features and p53 with p21 or p53 with pRB/p16, only p53 and lymph node metastases were associated with bladder cancer progression (P ≤ .026) and death (P ≤ .028). In models that included p21 and pRB/p16, only p21 and lymph node metastases were associated with bladder cancer progression (P ≤ .022) and death (P ≤ .028). In a model that included the combined variables p53/p21 and pRB/p16, only p53/p21 and lymph node status were associated with bladder cancer progression (P ≤ .047) and death (P ≤ .036). The incremental number of altered markers was independently associated with an increased risk of bladder cancer progression (P = .005) and mortality (P = .007). Conclusion Although altered expression of each of the four cell cycle regulators is associated with bladder cancer outcome in patients undergoing radical cystectomy, p53 is the strongest predictor, followed by p21, suggesting a more pivotal role of the p53/p21 pathway in bladder cancer progression.

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