Precystectomy Nomogram for Prediction of Advanced Bladder Cancer Stage

Karakiewicz, Pierre I.; Shariat, Shahrokh F.; Palapattu, Ganesh S.; Perrotte, Paul; Lotan, Yair; Rogers, Craig G.; Amiel, Gilad E.; Vazina, Amnon; Gupta, Amit; Bastian, Patrick J.; Sagalowsky, Arthur I.; Schoenberg, Mark; Lerner, Seth P.

doi:10.1016/j.eururo.2006.06.010

Cited by 152 publications

(105 citation statements)

References 21 publications

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“…Lymphadenectomy is performed at the time of cystectomy. Lymph node (LN) metastases, typically found in 20-25% of patients, are associated with increased local recurrence and disease progression, and may serve as an indicator of the need for further therapy [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

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Sentinel Lymph Node Mapping of Invasive Urinary Bladder Cancer in Animal Models Using Invisible Light

Knapp¹,

Adams²,

DeGrand

et al. 2007

European Urology

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Objectives-With conventional methodology, sentinel lymph node (SLN) mapping of invasive urinary bladder cancer is technically challenging. This study was performed to determine the utility of invisible, near-infrared fluorescent (NIRF) light for patient-specific SLN mapping, in real time under complete image guidance.Methods-Lymphatic tracers, injection volume, NIRF excitation fluence rate, light collection of emitted fluorescence, and degree of bladder distension were systematically optimized in normal dogs and pigs. SLN mapping was then performed in pet dogs with naturally occurring invasive transitional cell carcinoma (InvTCC) of the urinary bladder, which closely mimics the human disease.Results-NIRF albumin (hydrodynamic diameter [HD], 7.4 nm) and NIRF quantum dots (15-20 nm HD) injected into the bladder wall resulted in identification of draining lymph nodes (LNs) in under 3 min. In both species, considerable variability in the lymphatic drainage was observed among individuals. Optimal SLN mapping was achieved with the use of superficial, serosal injection of NIRF tracer, with the bladder distended to an intraluminal pressure of 20-40 cm H 2 O. In dogs with InvTCC, NIRF tracers identified SLNs that were confirmed histologically to harbor metastases.Conclusions-The use of invisible NIRF light permits real-time, patient-specific identification of SLNs that drain bladder cancer. Intraluminal bladder pressure is a key parameter that needs to be controlled for optimal results. KeywordsBladder cancer; Fluorescence; Intraoperative imaging; Sentinel lymph node mapping * Corresponding author. Purdue University, Department of Veterinary Clinical Sciences, Lynn Hall of Veterinary Medicine, 625 Harrison St, West Lafayette, IN 47907-2026. Tel.765-494-9900; Fax: 765-496-1108. E-mail address: knappd@purdue.edu (D.W. Knapp). Take-home message This article describes successful use of intraoperative near-infrared light to identify sentinel lymph nodes (SLNs) draining invasive urinary bladder cancer in animals. This technology will permit studies of a new approach to identify SLNs at the time of cystectomy.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers

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Section: Introductionmentioning

confidence: 99%

“…Lymphadenectomy provides prognostic information and contributes to long-term cancer control and possibly cure of InvTCC [2][3][4][5][6][7]. The extent to which LN dissection should occur, however, has not been completely defined [8,9].…”

Section: Introductionmentioning

confidence: 99%

Sentinel Lymph Node Mapping of Invasive Urinary Bladder Cancer in Animal Models Using Invisible Light

Knapp¹,

Adams²,

DeGrand

et al. 2007

European Urology

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“…We and others have previously shown that nomogram-based prediction models based on current histopathologic criteria can improve accuracy over AJCC-based stage groupings. [11][12][13][14] However, these models were not perfect and there is still a need to improve the predictive accuracy for the individual patient based on biologic information. Accurate prediction of response to therapy, disease recurrence, and survival may aid individual patient counseling, frequency and extent of monitoring, and adjuvant therapy planning.…”

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confidence: 99%

Multiple biomarkers improve prediction of bladder cancer recurrence and mortality in patients undergoing cystectomy

Shariat

Karakiewicz

Ashfaq

et al. 2007

Cancer

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182

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BACKGROUND.Tested was whether the assessment of 5 established bladder cancer biomarkers (p53, pRB, p21, p27, and cyclin E1) could improve the ability to predict disease recurrence and cancer‐specific survival after radical cystectomy in patients with pTa‐3N0M0 urothelial carcinoma of the bladder (UCB).METHODS.The study comprised 191 patients with pTa‐3N0M0 UCB treated with radical cystectomy and bilateral lymphadenectomy (median follow‐up, 3.1 years). Biomarker expression was assayed on serial tissue microarray slides using quantitative immunohistochemistry using advanced cell imaging and color detection software. Predictive accuracy was quantified using the concordance index and 200‐bootstrap resamples were used to reduce overfit bias. Bootstrap‐adjusted predictive accuracy estimates were compared using the Mantel‐Haenszel test.RESULTS.UCB recurred in 36 (18.8%) patients and 30 (15.7%) died of bladder cancer; 157 (82.2%) patients had altered expression of at least 1 biomarker. In univariate analyses the number of altered biomarkers had the highest predictive accuracy for both disease recurrence (76.8%, P < .001) and cancer‐specific mortality (78.3%, P < .001). Addition of the number of altered biomarkers increased the predictive accuracy of nomograms based on the TNM staging system for disease recurrence and cancer‐specific mortality by 10.9% (83.4% vs 72.5%, P < .001) and 8.6% (86.9% vs 78.3, P < .001), respectively.CONCLUSIONS.Assessment of the number of altered biomarkers in the cystectomy specimen improves the prediction of bladder cancer recurrence and survival in patients with pTa‐3N0M0 disease. Prospective evaluation of alteration in these biomarkers can help identify patients who would benefit from adjuvant treatment after radical cystectomy. Cancer 2008. © 2007 American Cancer Society.

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“…To date, the solitary nomogram to predict lymph node metastases at cystectomy was developed by Karakiewicz and colleagues based on clinical and pathological factors in a multicenter study [1]. Although this multivariate nomogram had a predictive accuracy of 63% for lymph node metastases, questions remain with regard to its accuracy as a result of the uncertainties surrounding the staging and PLND surgical techniques employed in this study cohort.…”

Section: Preoperative Assessment Of Pelvic Lymph Nodes Nomogramsmentioning

confidence: 99%

Indications, Extent, and Benefits of Pelvic Lymph Node Dissection for Patients with Bladder and Prostate Cancer

2009

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Target audience: Physicians who wish to advance their current knowledge of clinical cancer medicine in genitourinary cancer. LEARNING OBJECTIVES1. Evaluate all patients undergoing radical pelvic surgery to determine whether they should have pelvic lymph node dissection.2. Determine to what extent a pelvic lymph node dissection should be performed and analyze the risks involved.3. Based on best practices, assess whether pelvic lymph node dissection is beneficial for staging and prognosis.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACTThe role of pelvic lymph node dissection (PLND) in both bladder and prostate cancer has recently been generating renewed interest. In an attempt to avoid PLND, both nomograms and imaging studies have been evaluated; however, so far they have shown limited success because of inadequate accuracy in staging patients. The three primary objectives of this review are: to define patients in whom PLND should be performed, to define the extent and consequences of the template for PLND, and to identify the staging and prognostic benefits seen with PLND in bladder and prostate cancer. Based on the findings from this review, we conclude that PLND for bladder cancer patients is undoubtedly beneficial, whereas it is less so for prostate cancer patients, in whom a selection strategy should be employed. PLND, in particular with an extended template, seems to provide superior accuracy for postoperative staging than the presently available imaging studies and may be pivotal when considering adjuvant therapies. Furthermore, it has an impact on survival in high-risk patients, and potentially more so in low-risk cancer patients with occult metastases.

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Precystectomy Nomogram for Prediction of Advanced Bladder Cancer Stage

Cited by 152 publications

References 21 publications

Sentinel Lymph Node Mapping of Invasive Urinary Bladder Cancer in Animal Models Using Invisible Light

Sentinel Lymph Node Mapping of Invasive Urinary Bladder Cancer in Animal Models Using Invisible Light

Multiple biomarkers improve prediction of bladder cancer recurrence and mortality in patients undergoing cystectomy

Indications, Extent, and Benefits of Pelvic Lymph Node Dissection for Patients with Bladder and Prostate Cancer

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