Skip to main content

Advertisement

SpringerLink
Log in

The role of lymph node density in bladder cancer prognostication

  • Topic Paper
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Quek ML, Sanderson KM, Daneshmand S et al (2004) The importance of an extended lymphadenectomy in the management of high-grade invasive bladder cancer. Expert Rev Anticancer Ther 4:1007–1016. doi:10.1586/14737140.4.6.1007

    Article  PubMed  Google Scholar 

  2. Stein JP, Lieskovsky G, Cote R et al (2001) Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1, 054 patients. J Clin Oncol 19:666–675

    PubMed  CAS  Google Scholar 

  3. Shariat SF, Karakiewicz PI, Palapattu GS et al (2006) Outcomes of radical cystectomy for transitional cell carcinoma of the bladder: a contemporary series from the Bladder Cancer Research Consortium. J Urol 176:2414–2422. doi:10.1016/j.juro.2006.08.004; discussion 2422

    Article  PubMed  Google Scholar 

  4. Hautmann RE, Gschwend JE, de Petriconi RC et al (2006) Cystectomy for transitional cell carcinoma of the bladder: results of a surgery only series in the neobladder era. J Urol 176:486–492. doi:10.1016/j.juro.2006.03.038; discussion 491-2

    Article  PubMed  Google Scholar 

  5. Skinner DG (1982) Management of invasive bladder cancer: a meticulous pelvic node dissection can make a difference. J Urol 128:34–36

    PubMed  CAS  Google Scholar 

  6. Herr HW, Donat SM (2001) Outcome of patients with grossly node positive bladder cancer after pelvic lymph node dissection and radical cystectomy. J Urol 165:62–64. doi:10.1097/00005392-200101000-00015; discussion 64

    Article  PubMed  CAS  Google Scholar 

  7. Vieweg J, Gschwend JE, Herr HW et al (1999) Pelvic lymph node dissection can be curative in patients with node positive bladder cancer. J Urol 161:449–454. doi:10.1016/S0022-5347(01)61921-9

    Article  PubMed  CAS  Google Scholar 

  8. Lerner SP, Skinner DG, Lieskovsky G et al (1993) The rationale for en bloc pelvic lymph node dissection for bladder cancer patients with nodal metastases: long-term results. J Urol 149:758–764 discussion 764-5

    PubMed  CAS  Google Scholar 

  9. Mills RD, Turner WH, Fleischmann A et al (2001) Pelvic lymph node metastases from bladder cancer: outcome in 83 patients after radical cystectomy and pelvic lymphadenectomy. J Urol 166:19–23. doi:10.1016/S0022-5347(05)66067-3

    Article  PubMed  CAS  Google Scholar 

  10. Koppie TM, Vickers AJ, Vora K et al (2006) Standardization of pelvic lymphadenectomy performed at radical cystectomy: can we establish a minimum number of lymph nodes that should be removed? Cancer 107:2368–2374. doi:10.1002/cncr.22250

    Article  PubMed  Google Scholar 

  11. Konety BR, Joslyn SA, O’Donnell MA (2003) Extent of pelvic lymphadenectomy and its impact on outcome in patients diagnosed with bladder cancer: analysis of data from the Surveillance, Epidemiology and End Results Program data base. J Urol 169:946–950. doi:10.1097/01.ju.0000052721.61645.a3

    Article  PubMed  Google Scholar 

  12. Herr HW, Bochner BH, Dalbagni G et al (2002) Impact of the number of lymph nodes retrieved on outcome in patients with muscle invasive bladder cancer. J Urol 167:1295–1298. doi:10.1016/S0022-5347(05)65284-6

    Article  PubMed  Google Scholar 

  13. Vieweg J, Gschwend JE, Herr HW et al (1999) The impact of primary stage on survival in patients with lymph node positive bladder cancer. J Urol 161:72–76. doi:10.1016/S0022-5347(01)62067-6

    Article  PubMed  CAS  Google Scholar 

  14. Quek ML, Stein JP, Nichols PW et al (2005) Prognostic significance of lymphovascular invasion of bladder cancer treated with radical cystectomy. J Urol 174:103–106. doi:10.1097/01.ju.0000163267.93769.d8

    Article  PubMed  Google Scholar 

  15. Fleischmann A, Thalmann GN, Markwalder R et al (2005) Extracapsular extension of pelvic lymph node metastases from urothelial carcinoma of the bladder is an independent prognostic factor. J Clin Oncol 23:2358–2365. doi:10.1200/JCO.2005.03.084

    Article  PubMed  Google Scholar 

  16. Fleischmann A, Thalmann GN, Markwalder R et al (2005) Prognostic implications of extracapsular extension of pelvic lymph node metastases in urothelial carcinoma of the bladder. Am J Surg Pathol 29:89–95. doi:10.1097/01.pas.0000147396.08853.26

    Article  PubMed  Google Scholar 

  17. Stein JP, Cai J, Groshen S et al (2003) Risk factors for patients with pelvic lymph node metastases following radical cystectomy with en bloc pelvic lymphadenectomy: concept of lymph node density. J Urol 170:35–41. doi:10.1097/01.ju.0000072422.69286.0e

    Article  PubMed  Google Scholar 

  18. Herr HW (2003) Superiority of ratio based lymph node staging for bladder cancer. J Urol 169:943–945. doi:10.1097/01.ju.0000032474.22093.06

    Article  PubMed  Google Scholar 

  19. Kassouf W, Agarwal PK, Herr HW et al (2008) Lymph node density is superior to TNM nodal status in predicting disease-specific survival after radical cystectomy for bladder cancer: analysis of pooled data from MDACC and MSKCC. J Clin Oncol 26:121–126. doi:10.1200/JCO.2007.12.9247

    Article  PubMed  Google Scholar 

  20. Stein JP (2006) Lymphadenectomy in bladder cancer: how high is “high enough”? Urol Oncol 24:349–355. doi:10.1016/j.urolonc.2005.07.013

    PubMed  Google Scholar 

  21. Dhar NB, Klein EA, Reuther AM et al (2008) Outcome after radical cystectomy with limited or extended pelvic lymph node dissection. J Urol 179:873–878. doi:10.1016/j.juro.2007.10.076; discussion 878

    Article  PubMed  Google Scholar 

  22. Steven K, Poulsen AL (2007) Radical cystectomy and extended pelvic lymphadenectomy: survival of patients with lymph node metastasis above the bifurcation of the common iliac vessels treated with surgery only. J Urol 178:1218–1223. doi:10.1016/j.juro.2007.05.160; discussion 1223-4

    Article  PubMed  Google Scholar 

  23. Kassouf W, Leibovici D, Munsell MF et al (2006) Evaluation of the relevance of lymph node density in a contemporary series of patients undergoing radical cystectomy. J Urol 176:53–57. doi:10.1016/S0022-5347(06)00510-6; discussion 57

    Article  PubMed  Google Scholar 

  24. Abdel-Latif M, Abol-Enein H, El-Baz M et al (2004) Nodal involvement in bladder cancer cases treated with radical cystectomy: incidence and prognosis. J Urol 172:85–89. doi:10.1097/01.ju.0000132132.72351.4c

    Article  PubMed  Google Scholar 

  25. Wright JL, Lin DW, Porter MP (2008) The association between extent of lymphadenectomy and survival among patients with lymph node metastases undergoing radical cystectomy. Cancer 112:2401–2408. doi:10.1002/cncr.23474

    Article  PubMed  Google Scholar 

  26. Gilbert SM (2008) Separating surgical quality from causality–gaining perspective in the debate on lymph node count and extent of lymphadenectomy. Cancer 112:2331–2333. doi:10.1002/cncr.23471

    Article  PubMed  Google Scholar 

  27. Farshid G, Pradhan M, Kollias J et al (2000) Computer simulations of lymph node metastasis for optimizing the pathologic examination of sentinel lymph nodes in patients with breast carcinoma. Cancer 89:2527–2537. doi:10.1002/1097-0142(20001215)89:12<2527::AID-CNCR3>3.0.CO;2-6

    Article  PubMed  CAS  Google Scholar 

  28. Bochner BH, Herr HW, Reuter VE (2001) Impact of separate versus en bloc pelvic lymph node dissection on the number of lymph nodes retrieved in cystectomy specimens. J Urol 166:2295–2296. doi:10.1016/S0022-5347(05)65555-3

    Article  PubMed  CAS  Google Scholar 

  29. Herr HW (2007) The concept of lymph node density—is it ready for clinical practice? J Urol 177:1273–1275. doi:10.1016/j.juro.2006.11.094; discussion 1275-6

    Article  PubMed  Google Scholar 

  30. Kamat AM, Fisher MB (2007) Lymph node density: surrogate marker for quality of resection in bladder cancer? Expert Rev Anticancer Ther 7:777–779. doi:10.1586/14737140.7.6.777

    Article  PubMed  Google Scholar 

  31. Skinner EC, Stein JP, Skinner DG (2007) Surgical benchmarks for the treatment of invasive bladder cancer. Urol Oncol 25:66–71. doi:10.1016/j.urolonc.2006.05.010

    PubMed  Google Scholar 

  32. Stein JP, Penson DF, Cai J et al (2007) Radical cystectomy with extended lymphadenectomy: evaluating separate package versus en bloc submission for node positive bladder cancer. J Urol 177:876–881. doi:10.1016/j.juro.2006.10.043; discussion 881-2

    Article  PubMed  Google Scholar 

  33. Herr HW (2003) Surgical factors in bladder cancer: more (nodes) + more (pathology) = less (mortality). BJU Int 92:187–188. doi:10.1046/j.1464-410X.2003.04334.x

    Article  PubMed  CAS  Google Scholar 

  34. Herr HW (2003) Extent of surgery and pathology evaluation has an impact on bladder cancer outcomes after radical cystectomy. Urology 61:105–108. doi:10.1016/S0090-4295(02)02116-7

    Article  PubMed  Google Scholar 

  35. Woods ME, Ouwenga M, Quek ML (2007) The role of pelvic lymphadenectomy in the management of prostate and bladder cancer. ScientificWorldJournal 7:789–799. doi:10.1100/tsw.2007.148

    Article  PubMed  Google Scholar 

Download references

Conflict of interest statement

There is no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Urology, Loyola University Medical Center, Fahey Center, Room 261, 2160 South First Avenue, Maywood, IL, 60153, USA

    Marcus L. Quek & Robert C. Flanigan

Authors
  1. Marcus L. Quek
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert C. Flanigan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marcus L. Quek.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Quek, M.L., Flanigan, R.C. The role of lymph node density in bladder cancer prognostication. World J Urol 27, 27–32 (2009). https://doi.org/10.1007/s00345-008-0347-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-008-0347-z

Keywords

Search

Navigation