Influence of preoperatively detected circulating tumor cells on the outcome of patients with urothelial carcinoma of the bladder treated with radical cystectomy.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 268-268
Author(s):  
Michael Rink ◽  
Armin Soave ◽  
Felix K. Chun ◽  
Roland Dahlem ◽  
Sarah Minner ◽  
...  
Keyword(s):  
Lymph Node ◽  
Radical Cystectomy ◽  
Lymph Node Metastases ◽  
Disease Recurrence ◽  
Disease Outcome ◽  
Patient Counseling ◽  
Blood Samples ◽  
Nodal Stage ◽  
Cancer Of The Bladder ◽  
Node Metastases

268 Background: Circulating tumour cells (CTC) are frequently detectable in the peripheral blood of patients with urothelial cancer of the bladder (UCB) prior to radical cystectomy (RC). We hypothesize that CTC can predict advanced stages, nodal status and disease outcome after radical cystectomy and therefore represent an optimal biomarker for treatment decision making and patient counseling. Methods: Blood samples of 120 consecutive, clinically non-metastatic UCB patients scheduled for RC were prospectively investigated for CTC. Preoperatively collected blood samples (7.5 ml) were analysed for CTC using the CellSearch system (Veridex, USA). Uni- and multivariable models evaluated the association of CTC status and number of CTC with clinical and nodal stage and disease outcome. Results: CTC were detectable in 30/120 patients (25%) with an average number of 5.7±18.3 CTC (range:1-100; median:1). Eighteen patients (60.0%) had 1 CTC/7.5mL, 8 patients (26.7%) had 2-5 CTC and 4 patients (13.3%) had >5 CTC, respectively. CTC status was not associated with tumour stage, grade, lymph node metastases or lymphovascular invasion. Moreover, increasing numbers of CTC were not associated with higher stages or increasing numbers of lymph node metastases. However, at a median follow-up of 18 months (range:1-48 months) CTC detection prior to RC was an independent risk factor for disease recurrence (p<0.001, HR=4.9, 95%CI 2.1–11.7) and cancer-related death (p=0.002, HR=4.9, 95%CI 1.7-13.6). Disease recurrence and cancer-related death were not associated with the number of detected CTC. Conclusions: Although CTC can not predict pathological or nodal stage, they are associated with inferior disease outcome. Detection of even 1 CTC/7.5 mL blood in UCB patients prior to RC is an independent predictor for disease recurrence and cancer-related death. These findings are very important for future investigations, as they are in contradiction to theories supporting a cut-off value of 5 or more CTC needed for accurate outcome prediction. Therefore, CTC may represent a feasible biomarker for monitoring response to neoadjuvant and adjuvant chemotherapy.

1849 LOCATION OF TUMOR IN THE BLADDER PREDICTS LIKELIHOOD OF LYMPH NODE METASTASES AT RADICAL CYSTECTOMY AND DISEASE RECURRENCE

2011 ◽  
Vol 185 (4S) ◽  
Author(s):  
Robert Svatek ◽  
Clark Wilson ◽  
Vipal Durkal ◽  
Stephen Culp ◽  
H. Barton Grossman ◽  
...  
Keyword(s):  
Lymph Node ◽  
Radical Cystectomy ◽  
Lymph Node Metastases ◽  
Disease Recurrence ◽  
Node Metastases

RE: PELVIC LYMPH NODE METASTASES FROM BLADDER CANCER: OUTCOME IN 83 PATIENTS AFTER RADICAL CYSTECTOMY AND PELVIC LYMPHADENECTOMY

2002 ◽  
Vol 167 (2 Part 1) ◽  
pp. 651-651
Author(s):  
R.D. Mills ◽  
W.H. Turner ◽  
A. Fleischmann ◽  
R. Markwalder ◽  
G.N. Thalmann ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Lymph Node ◽  
Radical Cystectomy ◽  
Lymph Node Metastases ◽  
Pelvic Lymphadenectomy ◽  
Pelvic Lymph Node ◽  
Node Metastases ◽  
Cancer Outcome

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

2004 ◽  
Vol 22 (6) ◽  
pp. 1014-1024 ◽  
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.

The risk of nodal metastasis in early adenocarcinoma of the uterine cervix*

2004 ◽  
Vol 14 (1) ◽  
pp. 104-109 ◽  
Author(s):  
J. Balega ◽  
H. Michael ◽  
J. Hurteau ◽  
D. H. Moore ◽  
J. Santiesteban ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastases ◽  
Medical Center ◽  
Conservative Surgery ◽  
Disease Recurrence ◽  
Nodal Metastasis ◽  
Pelvic Lymphadenectomy ◽  
Depth Of Invasion ◽  
Nodal Metastases ◽  
Node Metastases

A functional and widely accepted definition of microinvasive cervical adenocarcinoma remains elusive. The purpose of this study was to determine at which depth of invasion the likelihood of lymph node metastasis or disease recurrence was so small that conservative surgery could be considered appropriate. Charts of patients with adenocarcinoma of the cervix (ACC) who underwent radical hysterectomy and pelvic lymphadenectomy (n = 98) at Indiana University Medical Center from 1987 to 1998 were retrospectively reviewed. Patients with stage IA1–IB1 lesions were included in the study. Patients treated with preoperative radiotherapy were excluded. Pathologic parameters evaluated included histologic type, depth of stromal invasion (DOI), and the presence of lymphatic vascular space invasion, or lymph node metastases. The patient median age was 39 years (20–65). The median time of follow-up was 30 months (4–124). Lymph node metastases were found in ten patients and 11 developed recurrences. The precise DOI could be measured in 84 patients. Of the 48 patients with cancers with a DOI ≤ 5 mm, none had involved parametria or nodes; whereas eight of the 36 with a DOI > 5 mm had nodal metastases (P = 0.00069). None of these 48 patients with a tumor DOI ≤ 5 mm developed a recurrence whereas six of the 36 patients with a tumor DOI > 5 mm developed recurrent disease (P = 0.0048). The risk of nodal metastases and recurrence is so low in patients with ACC and DOI ≤ 5 mm that for patients with such depth documented on conization with negative margins pelvic lymphadenectomy may be omitted.

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