Lymph node density: surrogate marker for quality of resection in bladder cancer?

Kamat, Ashish M.; Fisher, Mark B.

doi:10.1586/14737140.7.6.777

Cited by 5 publications

(4 citation statements)

References 17 publications

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“…[30] Of 133 patients undergoing cystectomy, those with a lymph node density >20% had a 5‐year disease‐specific survival rate of 0%, whereas those with a lymph node density <20% had a 5‐year disease‐specific survival of 54% ( P < 0.001) [30]. Similar findings, supporting the negative prognostic implications associated with a higher pelvic lymph node density, have also been reported in other studies, with cut‐off values ranging from 18 to 25%[20,39–43].…”

Section: Current Standardssupporting

confidence: 82%

Prognostic implications of lymph node involvement in bladder cancer: are we understaging using current methods?

et al. 2011

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To review the current and newer, alternative methods for evaluating lymph nodes for tumor involvement in bladder cancer as relapse rates for organ‐confined disease remain high despite improvements in surgical technique, suggesting the possibility of understaging. To propose a research agenda based on these findings. A PubMed literature search was performed to identify studies examining the prognostic implications of and outcomes associated with lymph node involvement in bladder cancer as well as those that utilized newer methodologies to identify the possibility for metastatic disease. Lymph node involvement remains one of the strongest predictors of clinical outcome in bladder cancer. Histologic and molecular techniques for identification of lymph node metastasis provide a sensitivity and specificity equal to if not higher than standard pathologic evaluation. Further research into this field would help to elucidate the potential utility of these techniques with regard to proper staging and potential relevance to clinical outcomes.

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Section: Current Standardssupporting

confidence: 82%

Prognostic implications of lymph node involvement in bladder cancer: are we understaging using current methods?

et al. 2011

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“…Lymph node density has been correlated with recurrence-free survival and has been found in some studies to be a better surrogate end point than total number of positive nodes. 4,8,9 Five-year survival rates have been listed as high as 64% for a lymph node density of less than 20% compared with only 8% for a lymph node density greater than 20%. 8,9 Some potential factors influencing lymph node count have been examined in bladder cancer patients treated by cystectomy and pelvic lymphadenectomy.…”

Section: Discussionmentioning

confidence: 99%

“…4,8,9 Five-year survival rates have been listed as high as 64% for a lymph node density of less than 20% compared with only 8% for a lymph node density greater than 20%. 8,9 Some potential factors influencing lymph node count have been examined in bladder cancer patients treated by cystectomy and pelvic lymphadenectomy. Ather et al 10 looked at separate submission of standard lymphadenectomy in six packets vs en bloc lymphadenectomy in bladder cancer.…”

Section: Discussionmentioning

confidence: 99%

“…Nearly all studies performed on this issue have confirmed the independent prognostic significance of lymph node density upon multivariate analysis, with a lymph node density of 20% being the most commonly used cut-off in the literature. 4,8,9 Underreporting total number of lymph nodes would change the denominator of the calculated lymph node density and thereby impact the statistical analysis of these studies. However, it is unclear how the pathologic processing was performed on the lymphadenectomy specimens in these studies or whether the entire specimen was submitted or not.…”

Section: Discussionmentioning

confidence: 99%

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Identifying additional lymph nodes in radical cystectomy lymphadenectomy specimens

et al. 2012

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Lymph node count has prognostic implications in bladder cancer patients who are treated with radical cystectomy. Lymph nodes that are too small to identify grossly can easily be missed, potentially leading to missed nodal metastases and inaccurate nodal counts, resulting in inaccurate prognoses. We investigated whether there is a benefit to submitting the entire lymph node packet for histological examination to identify additional lymph nodes. We prospectively assessed 61 pelvic lymphadenectomy specimens in 14 consecutive patients undergoing radical cystectomy. The specimens were placed in Carnoy's solution overnight, then analyzed for lymph nodes. The residual tissue was entirely submitted to assess for additional lymph nodes. In 61 specimens, we identified 391 lymph nodes, ranging from 4-44 nodes per patient. We identified 238 (61%) lymph nodes with standard techniques and 153 (39%) lymph nodes in submitted residual tissue. The number of additional lymph nodes found in the residual tissue ranged from 0 to 26 (0-75%) per patient. These lymph nodes ranged in size from 0.05 to 1 cm. All additional lymph nodes were negative for metastatic disease. Submitting the entire specimen for histological examination allowed for identification of more lymph nodes in radical cystectomy pelvic lymphadenectomy specimens. However, as none of the additional lymph nodes contained metastatic disease, it is unclear if there is a clinical benefit in evaluating lymph nodes that are neither visible nor palpable in lymphadenectomy specimens.

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The role of lymph node density in bladder cancer prognostication

Quek

Flanigan

2008

World J Urol

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Pelvic lymph node metastases from bladder cancer occur in about 25% of patients undergoing radical cystectomy. While the majority of patients with lymph node metastases will develop progressive disease, some patients do exhibit long-term survival with and without adjuvant chemotherapy. The concept of lymph node density has been proposed as a means to stratify patient prognosis since it takes into account two important factors-the number of positive nodes (tumor burden) and the total number of nodes removed/examined (extent of dissection). Due to the lack of agreement on the extent of lymphadenectomy, lymph node density facilitates standardization of lymph node staging, thus allowing for adjuvant therapies and clinical trials to be more uniformly applied. Whether lymph node density provides improved prognostication over the standard nodal staging or absolute number of positive lymph nodes remains controversial. We review the literature regarding the role of lymph node density in the prognostic stratification of node-positive bladder cancer.

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Lymph node density: surrogate marker for quality of resection in bladder cancer?

Cited by 5 publications

References 17 publications

Prognostic implications of lymph node involvement in bladder cancer: are we understaging using current methods?

Prognostic implications of lymph node involvement in bladder cancer: are we understaging using current methods?

Identifying additional lymph nodes in radical cystectomy lymphadenectomy specimens

The role of lymph node density in bladder cancer prognostication

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