1
|
Moeen AM, Hameed DA, Mostafa MG, Shaban SH. Lymphadenectomy before and after radical cystectomy: does this affect the radicality? A prospective randomized comparative study. Int Urol Nephrol 2024; 56:965-972. [PMID: 37845400 PMCID: PMC10853289 DOI: 10.1007/s11255-023-03826-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 09/26/2023] [Indexed: 10/18/2023]
Abstract
PURPOSE To compare the oncological outcome of performing ePLND before or after RC in 200 patients in a prospective randomized manner. MATERIALS AND METHODS From January 2014 to December 2019, 200 patients with T2-T3b N0M0 BCa were included in the current study after signing an informed consent. Patients were divided into two groups, 100 in each one. Group I underwent ePLND before RC, whereas group II underwent ePLND after RC. Postoperative evaluation included clinical, laboratory, and radiographic studies. RESULTS Patients' characteristics were comparable between both groups. The mean operative time excluding that of urinary diversion was significantly shorter in group II than in group I (p = 0.01). The mean number of LNs removed was 25 ± 6 in group I and 32 ± 8 in group II (p = 0.141). Intraoperative complications occurred in four patients in the form of external iliac artery and vein injury [two in each group (p = 0. 245)]. Postoperative complications were comparable between both groups with no statistically significant difference (p = 0.375). Oncological failure occurred in 28 patients [16 (17.6%) in group I and 12 (22%) in group II (p = 0.389)]. CONCLUSIONS EPLND before and after RC has comparable oncological outcomes. The stage of the disease, the time since the first diagnosis till RC and the surgeon experience in performing meticulous ePLND are more important. In absence of oncological superiority, the timing of ePLND should be judged according to the patient-related factors to facilitate safe RC with minimal morbidity.
Collapse
Affiliation(s)
- Ahmed M Moeen
- Urology Department, Assiut University, Asyut, Egypt.
| | | | | | | |
Collapse
|
2
|
Fan Z, Deng J, Wang Y, Fan X, Xie J. Bladder Cancer: Immunotherapy and Pelvic Lymph Node Dissection. Vaccines (Basel) 2024; 12:150. [PMID: 38400134 PMCID: PMC10893107 DOI: 10.3390/vaccines12020150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/16/2023] [Accepted: 12/28/2023] [Indexed: 02/25/2024] Open
Abstract
Bladder cancer, a common malignancy of the urinary system, is routinely treated with radiation, chemotherapy, and surgical excision. However, these strategies have inherent limitations and may also result in various side effects. Immunotherapy has garnered considerable attention in recent years as a novel therapeutic approach. It harnesses and activates the patient's immune system to recognize and eliminate cancer cells, which not only prolongs therapeutic efficacy but also minimizes the toxic side effects. Several immune checkpoint inhibitors and cancer vaccines have been developed for the treatment of bladder cancer. Whereas blocking immune checkpoints on the surface of tumor cells augments the effect of immune cells, immunization with tumor-specific antigens can elicit the production of anti-tumor immune effector cells. However, there are several challenges in applying immunotherapy against bladder cancer. For instance, the efficacy of immunotherapy varies considerably across individual patients, and only a small percentage of cancer patients are responsive. Therefore, it is crucial to identify biomarkers that can predict the efficacy of immunotherapy. Pelvic lymph nodes are routinely dissected from bladder cancer patients during surgical intervention in order to remove any metastatic tumor cells. However, some studies indicate that pelvic lymph node dissection may reduce the efficacy of immunotherapy by damaging the immune cells. Therefore, the decision to undertake pelvic lymph node removal should be incumbent on the clinical characteristics of individual patients. Thus, although immunotherapy has the advantages of lower toxic side effects and long-lasting efficacy, its application in bladder cancer still faces challenges, such as the lack of predictive biomarkers and the effects of pelvic lymph node dissection. Further research is needed to explore these issues in order to improve the efficacy of immunotherapy for bladder cancer.
Collapse
Affiliation(s)
- Zhongru Fan
- Department of Urology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Nanjing 211166, China
| | - Junpeng Deng
- Department of Urology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Nanjing 211166, China
| | - Yutao Wang
- Department of Urology, Peking Union Medical Hospital, Beijing 100005, China
| | - Xin Fan
- Department of Radiology, The Second Affiliated Hospital of Dalian, Medical University, Dalian 116044, China
| | - Jianjun Xie
- Department of Urology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Nanjing 211166, China
| |
Collapse
|
3
|
Katims AB, Bochner BH. Extended pelvic lymph node dissection in muscle invasive bladder cancer. Curr Opin Urol 2023; 33:252-257. [PMID: 37021936 DOI: 10.1097/mou.0000000000001096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
PURPOSE OF REVIEW Bilateral pelvic lymph node dissection (PLND) at the time of radical cystectomy (RC) provides important staging information and oncologic benefit in patients with bladder cancer. The optimal extent of the PLND remains controversial. Our aim is to highlight nodal mapping studies and the data that guides optimization of both staging and oncologic outcomes. We then review contemporary randomized trials studying the extent of PLND. RECENT FINDINGS A recent randomized trial (RCT) powered for a 15% improvement in recurrence-free survival (RFS) of extended (e) over limited (l)PLND was completed but failed to identify this large difference in outcome. Concerns over study design limit the ability to interpret the oncologic results. Importantly, ePLND minimally changed surgical morbidity. An ongoing, similar RCT (SWOG S1011) powered to detect a 10% difference in RFS has completed accrual, but no published outcomes are available. SUMMARY RC and ePLND can provide cure in 33% of LN positive bladder cancer patients. Current data support a 5% improvement in RFS if ePLND is routinely used in MIBC patients. Two randomized trials powered to identify much larger (15 and 10%) improvements in RFS are unlikely to identify such an ambitious benefit by extending the PLND.
Collapse
Affiliation(s)
- Andrew B Katims
- Memorial Sloan Kettering Cancer Center, Department of Surgery, Urology Service, New York, New York, USA
| | | |
Collapse
|
4
|
Borgheresi A, Agostini A, Sternardi F, Cesari E, Ventura F, Ottaviani L, Delle Fave RF, Pretore E, Cimadamore A, Filosa A, Galosi AB, Giovagnoni A. Vascular Enlargement as a Predictor of Nodal Involvement in Bladder Cancer. Diagnostics (Basel) 2023; 13:2227. [PMID: 37443621 DOI: 10.3390/diagnostics13132227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/22/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
In bladder cancer (BC), the evaluation of lymph node (LN) involvement at preoperative imaging lacks specificity. Since neoangiogenesis is paired with lymphatic involvement, this study aims to evaluate the presence of perivesical venous ectasia as an indirect sign of LN involvement, together with other conventional CT findings. All the patients who underwent radical cystectomy (RC) for BC between January 2017 and December 2019 with available preoperative contrast-enhanced CT (CECT) within 1 month before surgery were included. Patients without available pathological reports (and pTNM stage) or who underwent neoadjuvant treatments and palliative RC were excluded. Two readers in blind assessed the nodal shape and hilum, the short axis, and the contrast enhancement of suspicious pelvic LNs, the Largest Venous Diameter (LVD) efferent to the lesion, and the extravesical tumor invasion. In total, 38 patients (33 males) were included: 17 pT2, 17 pT3, 4 pT4; pN+: 20/38. LN short axis > 5 mm, LN enhancement, and LVD > 3 mm were significantly correlated with N+ at pathology. LVD > 3 mm had a significantly higher sensitivity and specificity (≥90%, AUC = 0.949) and was an independent predictor (p = 0.0016).
Collapse
Affiliation(s)
- Alessandra Borgheresi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10, 60126 Ancona, Italy
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria delle Marche, Via Conca 71, 60126 Ancona, Italy
| | - Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10, 60126 Ancona, Italy
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria delle Marche, Via Conca 71, 60126 Ancona, Italy
| | - Francesca Sternardi
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria delle Marche, Via Conca 71, 60126 Ancona, Italy
| | - Elisa Cesari
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10, 60126 Ancona, Italy
| | - Fiammetta Ventura
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10, 60126 Ancona, Italy
| | - Letizia Ottaviani
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria delle Marche, Via Conca 71, 60126 Ancona, Italy
| | | | - Eugenio Pretore
- Division of Urology, Azienda Ospedaliero Universitaria delle Marche, Via Conca 71, 60126 Ancona, Italy
| | - Alessia Cimadamore
- Division of Pathology, Azienda Ospedaliero Universitaria delle Marche, Via Conca 71, 60126 Ancona, Italy
- Department of Biomedical Sciences and Public Healthcare, University Politecnica delle Marche, Via Tronto 10, 60126 Ancona, Italy
| | - Alessandra Filosa
- Division of Pathology, Azienda Ospedaliero Universitaria delle Marche, Via Conca 71, 60126 Ancona, Italy
- Department of Biomedical Sciences and Public Healthcare, University Politecnica delle Marche, Via Tronto 10, 60126 Ancona, Italy
| | - Andrea Benedetto Galosi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10, 60126 Ancona, Italy
- Division of Urology, Azienda Ospedaliero Universitaria delle Marche, Via Conca 71, 60126 Ancona, Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10, 60126 Ancona, Italy
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria delle Marche, Via Conca 71, 60126 Ancona, Italy
| |
Collapse
|
5
|
Rocco B, Eissa A, Gaia G, Assumma S, Sarchi L, Bozzini G, Micali S, Calcagnile T, Sighinolfi MC. Pelvic lymph node dissection in prostate and bladder cancers. Minerva Urol Nephrol 2022; 74:680-694. [PMID: 36197698 DOI: 10.23736/s2724-6051.22.04904-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Prostate cancer and bladder cancer accounts for approximately 13.5% and 3% of all male cancers and all newly diagnosed cancers (regardless sex), respectively. Thus, these cancers represent a major health and economic burden globally. The knowledge of lymph node status is an integral part of the management of any solid tumor. In the urological field, pelvic lymph node dissection (PLND) is of paramount importance in the diagnosis, management, and prognosis of prostate and bladder cancers. However, PLND may be associated with several comorbidities. In this narrative review, the most recent updates concerning the patterns and incidence of lymph node metastasis, the role of different imaging studies and nomograms in determining patients' eligibility for PLND, and the anatomical templates of PLND in urologic patients with bladder or prostate cancer will be discussed.
Collapse
Affiliation(s)
- Bernardo Rocco
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Ahmed Eissa
- Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt -
| | - Giorgia Gaia
- Department of Obstetrics and Gynecology, ASST Santi Paolo e Carlo, Milan, Italy
| | - Simone Assumma
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Sarchi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Tommaso Calcagnile
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria C Sighinolfi
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| |
Collapse
|
6
|
Robot-assisted radical cystectomy: surgical technique, perioperative and oncologic outcomes. Curr Opin Urol 2022; 32:116-122. [PMID: 34798640 DOI: 10.1097/mou.0000000000000953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Radical cystectomy is a complex procedure that encompasses surgery involving the urinary, gastrointestinal tracts and the retroperitoneum, with significant morbidity. Robot-assisted radical cystectomy (RARC) has been introduced to improve perioperative outcomes. RECENT FINDINGS It has been shown to provide equivalent oncologic outcomes to open radical cystectomy while providing some benefits in terms of perioperative outcomes. A complete intracorporeal approach utilizing intracorporeal urinary diversion may potentially offer additional benefits. SUMMARY Herein, we describe our technique for RARC and intracorporeal urinary diversion, as well as a review of oncologic and perioperative outcomes.
Collapse
|
7
|
Understanding the Lymphatics: An Updated Review of the N Category of the AJCC 8th Edition for Urogenital Cancers. AJR Am J Roentgenol 2021; 217:368-377. [DOI: 10.2214/ajr.20.22997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
8
|
Jena R, Shrivastava N, Sharma AP, Choudhary GR, Srivastava A. The Adequacy of Pelvic Lymphadenectomy During Radical Cystectomy for Carcinoma Urinary Bladder: A Narrative Review of Literature. Front Surg 2021; 8:687636. [PMID: 34222323 PMCID: PMC8247657 DOI: 10.3389/fsurg.2021.687636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/19/2021] [Indexed: 11/24/2022] Open
Abstract
An adequate pelvic lymph node dissection (PLND) is an essential part of radical cystectomy for muscle invasive bladder cancer. However, the definition of what constitutes an adequate PLND is often shrouded in controversy. Various authors have defined different anatomic templates of PLND based on levels of pelvic lymph nodes. Some have suggested other surrogate markers of the adequacy of PLND, namely lymph node count and lymph node density. While individual studies have shown the efficacy and reliability of some of the above markers, none of them have been recommended forthright due to the absence of robust prospective data. The use of non-standardized nomenclature while referring to the above variables has made this matter more complex. Most of older data seems to favor use of extended template of PLND over the standard template. On the other hand, one recent randomized controlled trial (RCT) did not show any benefit of one template over the other in terms of survival benefit, but the study design allowed for a large margin of bias. Therefore, we conducted a systematic search of literature using EMBASE, Medline, and PubMed using PRISMA-P checklist for articles in English Language published over last 20 years. Out of 132 relevant articles, 47 articles were included in the final review. We have reviewed existing literature and guidelines and have attempted to provide a few suggestions toward a uniform nomenclature for the various anatomical descriptions and the extent of PLND done while doing a radical cystectomy. The results of another large RCT (SWOG S1011) are awaited and until we have a definitive evidence, we should adhere to these suggestions as much as possible and deal with each patient on a case to case basis.
Collapse
Affiliation(s)
- Rahul Jena
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, India
| | - Nikita Shrivastava
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, India
| | - Aditya Prakash Sharma
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Aneesh Srivastava
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| |
Collapse
|
9
|
Małkiewicz B, Kiełb P, Gurwin A, Knecht K, Wilk K, Dobruch J, Zdrojowy R. The Usefulness of Lymphadenectomy in Bladder Cancer-Current Status. ACTA ACUST UNITED AC 2021; 57:medicina57050415. [PMID: 33922894 PMCID: PMC8145304 DOI: 10.3390/medicina57050415] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/19/2021] [Accepted: 04/23/2021] [Indexed: 12/13/2022]
Abstract
The purpose of this review is to present the current status of lymph node dissection (LND) during radical cystectomy in patients with bladder cancer (BCa). Despite the growing body of evidence of LND utility at the time of radical cystectomy (RC) in high-risk nonmuscle-invasive and muscle-invasive BCa (MIBC), therapeutic and prognostic value and optimal extent of LND remain unsolved issues. Recently published results of the first prospective, a randomized trial assessing the therapeutic benefit of extended versus limited LND during RC, failed to demonstrate survival improvement with the extended template. Although LND is the most accurate staging procedure, the direct therapeutic effect is still not evident from the current literature, limiting the possibility of establishing clear recommendations. This indicates the need for robust and adequately powered clinical trials.
Collapse
Affiliation(s)
- Bartosz Małkiewicz
- Department of Urology and Oncologic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (A.G.); (K.K.); (K.W.); (R.Z.)
- Correspondence: ; Tel.: +48-506-158-136
| | - Paweł Kiełb
- Department of Urology and Oncologic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (A.G.); (K.K.); (K.W.); (R.Z.)
| | - Adam Gurwin
- Department of Urology and Oncologic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (A.G.); (K.K.); (K.W.); (R.Z.)
| | - Klaudia Knecht
- Department of Urology and Oncologic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (A.G.); (K.K.); (K.W.); (R.Z.)
| | - Karol Wilk
- Department of Urology and Oncologic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (A.G.); (K.K.); (K.W.); (R.Z.)
| | - Jakub Dobruch
- First Department of Urology, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland;
| | - Romuald Zdrojowy
- Department of Urology and Oncologic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (A.G.); (K.K.); (K.W.); (R.Z.)
| |
Collapse
|
10
|
Kutluhan MA, Özsoy E, Başkak F, Ürkmez A, Topaktaş R, Koca O. How reliable are imaging techniques in aging males with bladder cancer? Aging Male 2020; 23:1339-1345. [PMID: 32401117 DOI: 10.1080/13685538.2020.1766014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION The aim of this study was to evaluate consistency between clinical lymph node positivity and pathological lymph node positivity in patients undergoing open radical cystectomy and pelvic lymph node dissection due to bladder cancer. MATERIAL AND METHOD A total of 135 patients who had open radical cystectomy, extended lymph node dissection, and clear preoperative contrast-enhanced abdominopelvic computed tomography (CT) or magnetic resonance imaging (MRI) images were included in the study. Positive clinical lymph nodes and positive pathological lymph nodeswere recorded. The largest positive clinical and pathological lymph nodeswere recorded. In terms of clinical lymph node involvement, compatibility between radiological findings and pathological results was evaluated. RESULTS In the CT group, the sensitivity was 25.81%, specificity was 95.45%, positive predictive value (PPV) was 66.67%, negative predictive value (NPV) was 78.50%, and accuracy was 77.31%. In the MRI group, the sensitivity was 50.00%, specificity was 100%, PPV was 100%, NPV was 76.92%, and accuracy was 81.25%. For consistency between pathological lymph nodes and clinical lymph nodes according to the imaging type, there was no statistically significant difference in the sensitivity, specificity, NPV, and accuracy rates between the imaging techniques (p > 0.05). However, the PPV was significantly higher in the MRI group than the CT group (100% vs.66.67%, respectively; p = 0.014). CONCLUSION Positive lymph nodes play a critical role in the prognosis of patients with bladder cancer and the sensitivity of contrast-enhanced abdominopelvic CT and MRI used routinely in clinical practice is low in lymph node detection. MRI seems more reliable than CT in lymph node detection.
Collapse
Affiliation(s)
- Musab Ali Kutluhan
- Department of Urology, Istanbul, Health Sciences University, Fatih Sultan Mehmet Training and Research Hospital, Turkey
| | - Emrah Özsoy
- Department of Urology, Health Sciences University, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Fulya Başkak
- Department of Radiology, Health Sciences University, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Ürkmez
- Department of Urology, Istanbul, Health Sciences University, Fatih Sultan Mehmet Training and Research Hospital, Turkey
| | - Ramazan Topaktaş
- Department of Urology, Health Sciences University, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Orhan Koca
- Medistate Private Hospital, Istanbul, Turkey
| |
Collapse
|
11
|
Packiam VT, Tsivian M, Boorjian SA. The evolving role of lymphadenectomy for bladder cancer: why, when, and how. Transl Androl Urol 2020; 9:3082-3093. [PMID: 33457281 PMCID: PMC7807370 DOI: 10.21037/tau.2019.06.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Radical cystectomy (RC) represents a standard treatment for non-metastatic muscle-invasive and select high-risk non-muscle invasive bladder cancer. Lymphadenectomy performed at time of RC identifies nodal metastases in up to 25% of patients despite normal imaging. There has been an increasing utilization of pelvic lymph node dissection (PLND) with RC since 1950, and in fact lymph node dissection is now recommended in contemporary National Comprehensive Cancer Network (NCCN) guidelines. Benefits of removing of nodal disease include improved staging, guidance for adjuvant treatment, and potentially improved oncologic outcomes. Advantages of dissection have been suggested among both node-negative and node-positive patients. Numerous studies have attempted to define the optimal dissection characteristics of lymphadenectomy with regard to nodal yield and anatomic boundaries of dissection. The ideal extent of lymphadenectomy remains uncertain due to the retrospective and non-randomized nature of the majority of existing reports, which are thereby limited by significant confounding and selection bias. Two randomized controlled trials have investigated this issue, one of which LEA AUO AB 25/02 recently reported its outcomes, demonstrating no significant improvement in 5-year outcomes with an extended dissection. Meanwhile, the Southwest Oncology Group 1011 trial has completed enrollment and data are maturing. While current data preclude definitive recommendations, herein we review the why, when, and how to perform a PLND for bladder cancer.
Collapse
|
12
|
Dawson V, Sinha M, Smith J, Somani BK, Douglas J. The role of extended lymph node dissection in patients undergoing radical cystectomy. Turk J Urol 2020; 47:S27-S32. [PMID: 33052839 DOI: 10.5152/tud.2020.20376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/03/2020] [Indexed: 11/22/2022]
Abstract
Radical cystectomy (RC) with a pelvic lymph node dissection (LND) is the gold standard for the treatment of muscle invasive bladder cancer (MIBC) as well as for some high-risk non-muscle invasive bladder cancers. The therapeutic advantage of LND, in terms of cancer-specific survival (CSS), still divides opinion and, certainly, the question of the extent of LND at the time of cystectomy is still debated. In this article, we have reviewed the evidence supporting the practice of extending LND in order to help clinicians determine what is appropriate in their practice. There still remains a lack of prospective randomized studies addressing whether extended LND provides a survival benefit in patients undergoing RC for BC. However, there is large body of evidence that suggests there is a positive impact on the oncological outcomes in these patients without an apparent cost of unacceptable adverse events.
Collapse
Affiliation(s)
- Victoria Dawson
- Urological Surgery Department, University Hospital Southampton NHS Trust, Southampton, UK
| | - Mriganka Sinha
- Urological Surgery Department, University Hospital Southampton NHS Trust, Southampton, UK
| | - Julian Smith
- Urological Surgery Department, University Hospital Southampton NHS Trust, Southampton, UK
| | - Bhaskar K Somani
- Urological Surgery Department, University Hospital Southampton NHS Trust, Southampton, UK
| | - James Douglas
- Urological Surgery Department, University Hospital Southampton NHS Trust, Southampton, UK
| |
Collapse
|
13
|
Heck MM, Gschwend JE. Extended Lymph Node Dissection for Bladder Cancer: Do Clinical Trials Rule Out a Benefit? Eur Urol Focus 2020; 6:617-619. [PMID: 31439506 DOI: 10.1016/j.euf.2019.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 08/01/2019] [Indexed: 10/26/2022]
Abstract
Although previous studies indicated a therapeutic benefit from superextended or extended lymph node dissection in bladder cancer patients undergoing radical cystectomy, the first prospective randomized trial could not confirm a significant survival benefit. With multimodal approaches including neoadjuvant or adjuvant chemotherapy as a gold standard, demonstrating any benefit may become even more difficult.
Collapse
Affiliation(s)
- Matthias M Heck
- Department of Urology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
| | - Jürgen E Gschwend
- Department of Urology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| |
Collapse
|
14
|
Zarifmahmoudi L, Ghorbani H, Sadeghi R, Sadri K, Tavakkoli M, Keshvari M, Salehi M. Sentinel lymph node biopsy in muscle-invasive bladder cancer: single-center experience. Ann Nucl Med 2020; 34:718-724. [PMID: 32656648 DOI: 10.1007/s12149-020-01502-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/28/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE In this study, the validity of sentinel node biopsy procedure as our index test was assessed and compared with bilateral pelvic lymphadenectomy for staging and detecting the regional lymph nodes metastasis in patients with muscle-invasive bladder cancer (MIBC). METHODS Consecutive series of cases with T1-T4 urothelial MIBC were included. Following the injection of radiotracer, sentinel nodes were sought using a handheld gamma probe and all hot nodes were harvested. Bilateral pelvic lymphadenectomy was done for all patients following sentinel node biopsy. The tumor specimen, sentinel nodes, and excised lymph nodes were evaluated histopathologically. Same as the other midline tumors, detection rate and false negative rates were calculated using patient basis and side basis methods. RESULTS By evaluating each patient as a unit of analysis, sentinel nodes were detected in 35 of 41 patients (85%), 13/16 (81%) of the neoadjuvant chemotherapy (NAC) and 22/25 (88%) of the no-neoadjuvant chemotherapy (No-NAC) participants. The false negative rate was 3/7 (42%): 1/3 (33%) for NAC, and 2/4 (50%) for No-NAC patients. By evaluating each hemipelvis as a unit of analysis, sentinel nodes were detected in 53 of 82 hemipelves (65%), 19/32 (66%) of the NAC, and 34/50 (68%) of the No-NAC hemipelves. No false-negative result was found by assessing each hemipelvis as a unit of analysis. CONCLUSIONS Sentinel node biopsy is a feasible method for lymph node staging in MIBC, including patients with a history of NAC. To optimize the sensitivity, the decision regarding the lymphadenectomy is best to be based on the pathological status of sentinel node harvested from each hemipelvis separately as the unilateral finding of a sentinel node, does not rule out the possibility of metastatic involvement of contralateral pelvic lymph nodes.
Collapse
Affiliation(s)
- Leili Zarifmahmoudi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamidreza Ghorbani
- Department of Urology, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Ramin Sadeghi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Kayvan Sadri
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahmoud Tavakkoli
- Department of Urology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maliheh Keshvari
- Department of Urology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Salehi
- Department of Community Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
15
|
Kagan J, Alemozaffar M, Carthon B, Osunkoya AO. Surgical Pathology Findings in Patients Who Have Undergone Radical Cystectomy/Cystoprostatectomy With Extended Versus Standard Lymph Node Dissection for Urothelial Carcinoma of the Bladder: A Contemporary Analysis. Int J Surg Pathol 2020; 29:150-154. [PMID: 32573301 DOI: 10.1177/1066896920937072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Radical cystectomy/cystoprostatectomy with pelvic lymph node dissection (with or without neoadjuvant chemotherapy) is the gold standard in the management of patients with urothelial carcinoma (UCa) with muscularis propria (detrusor muscle) invasion. However, it remains controversial how extensive the lymph node dissection should be. In this article, we analyzed the clinicopathologic findings in patients who had radical cystectomy/cystoprostatectomy with extended versus standard lymph node dissection. A search was made through our Urologic Pathology files for radical cystectomy/cystoprostatectomy cases with extended and standard lymph node dissection for UCa. A total of 264 cases were included in the study (218 cystoprostatectomy and 46 cystectomy specimens). Mean patients age was 68 years (range = 32-92 years). Patients in all stage categories had more extended lymph node dissection performed compared with standard lymph node dissection: pT0 (20 vs 7), pTis (40 vs 12), pTa (8 vs 4), pT1 (27 vs 5), pT2 (39 vs 8), pT3 (51 vs 17), and pT4 (18 vs 8). In cases with neoadjuvant therapy there was a 19% lymph node positivity rate compared with a 24% positivity rate in those with no presurgical therapy. The only cases categorized as pT2 and below with positive lymph node metastasis were those that had extended lymph node dissection performed. Positive lymph nodes were more frequently detected in cases that had extended lymph node dissection. More than 35% of the positive lymph nodes were in nonregional distribution. Extended lymph node dissection should be considered in patients with UCa even in the low stage or post-neoadjuvant chemotherapy setting.
Collapse
Affiliation(s)
| | | | | | - Adeboye O Osunkoya
- 1371Emory University, Atlanta, GA, USA.,Veterans Affairs Medical Center, Decatur, GA, USA
| |
Collapse
|
16
|
Xie W, Bi J, Wei Q, Han P, Song D, Shi L, Ye D, Shen Y, Gou X, He W, Wang S, Liu Z, Fan J, Wu K, Chen Z, Zhou X, Kong C, Liu Y, Liu C, Xu A, Jin B, Fu G, Xue W, Chen H, Pan T, Tu Z, Lin T, Huang J. Survival after radical cystectomy for bladder cancer: Multicenter comparison between minimally invasive and open approaches. Asian J Urol 2020; 7:291-300. [PMID: 32742929 PMCID: PMC7385523 DOI: 10.1016/j.ajur.2020.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/01/2020] [Accepted: 04/26/2020] [Indexed: 02/08/2023] Open
Abstract
Objective To investigate oncological outcomes in patients with bladder cancer who underwent minimally invasive radical cystectomy (MIRC) or open radical cystectomy (ORC). Methods We identified patients with bladder cancer who underwent radical cystectomy (RC) in 13 centers of the Chinese Bladder Cancer Consortium (CBCC). Perioperative outcomes were compared between MIRC and ORC. The influence of surgical approaches on overall survival (OS) and cancer-specific survival (CSS) in the entire study group and subgroups classified according to pathologic stage or lymph node (LN) status was assessed with the log-rank test. Multivariable Cox proportional hazard models were used to evaluate the association among OS, CSS and risk factors of interest. Results Of 2 098 patients who underwent RC, 1 243 patients underwent MIRC (1 087 laparoscopic RC and 156 robotic-assisted RC, respectively), while 855 patients underwent ORC. No significant differences were noted in positive surgical margin rate and 90-day postoperative mortality rate. MIRC was associated with less estimated blood loss, more LN yield, higher rate of neobladder diversion, longer operative time, and longer length of hospital stay. There was no significant difference in OS and CSS according to surgical approaches (p=0.653, and 0.816, respectively). Subgroup analysis revealed that OS and CSS were not significantly different regardless of the status of extravesical involvement or LN involvement. Multivariable Cox regression analyses showed that the surgical approach was not a significant predictor of OS and CSS. Conclusions Our study showed that MIRC was comparable to conventional ORC in terms of OS and CSS.
Collapse
Affiliation(s)
- Weibin Xie
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Junming Bi
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Qiang Wei
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Ping Han
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Dongkui Song
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lei Shi
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dingwei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yijun Shen
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xin Gou
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Weiyang He
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zheng Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinhai Fan
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Kaijie Wu
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhiwen Chen
- Department of Urology, First Affiliated Hospital of Army Medical University, Urology Institute of People Liberation Army, Chongqing, China
| | - Xiaozhou Zhou
- Department of Urology, First Affiliated Hospital of Army Medical University, Urology Institute of People Liberation Army, Chongqing, China
| | - Chuize Kong
- Department of Urology, The First Hospital of China Medical University, Shenyang, China
| | - Yang Liu
- Department of Urology, The First Hospital of China Medical University, Shenyang, China
| | - Chunxiao Liu
- Department of Urology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Abai Xu
- Department of Urology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Baiye Jin
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Guanghou Fu
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wei Xue
- Department of Urology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Haige Chen
- Department of Urology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Tiejun Pan
- Department of Urology, General Hospital of Central Theater Command of the People's Liberation Army, Wuhan, China
| | - Zhong Tu
- Department of Urology, General Hospital of Central Theater Command of the People's Liberation Army, Wuhan, China
| | - Tianxin Lin
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jian Huang
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| |
Collapse
|
17
|
Chen JJ, Zhu ZS, Zhu YY, Shi HQ. Applied anatomy of pelvic lymph nodes and its clinical significance for prostate cancer:a single-center cadaveric study. BMC Cancer 2020; 20:330. [PMID: 32299388 PMCID: PMC7164256 DOI: 10.1186/s12885-020-06833-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 04/06/2020] [Indexed: 11/21/2022] Open
Abstract
Background Pelvic lymph node dissection (PLND) is one of the most important steps in radical prostatectomy (RP). Not only can PLND provide accurate clinical staging to guide treatment after prostatectomy but PLND can also improve the prognosis of patients by eradicating micro-metastases. However, reports of the number of pelvic lymph nodes have generally come from incomplete dissection during surgery, there is no anatomic study that assesses the number and variability of lymph nodes. Our objective is to assess the utility of adopting the lymph node count as a metric of surgical quality for the extent of lymph node dissection during RP for prostate cancer by conducting a dissection study of pelvic lymph nodes in adult male cadavers. Methods All 30 adult male cadavers underwent pelvic lymph node dissection (PLND), and the lymph nodes in each of the 9 dissection zones were enumerated and analyzed. Results A total of 1267 lymph nodes were obtained. The number of lymph nodes obtained by limited PLND was 4–22 (14.1 ± 4.5), the number obtained by standard PLND was 16–35 (25.9 ± 5.6), the number obtained by extended PLND was 17–44 (30.0 ± 7.0), and the number obtained by super-extended PLDN was 24–60 (42.2 ± 9.7). Conclusions There are substantial inter-individual differences in the number of lymph nodes in the pelvic cavity. These results have demonstrated the rationality and feasibility of adopting lymph node count as a surrogate for evaluating the utility of PLND in radical prostatectomy, but these results need to be further explored.
Collapse
Affiliation(s)
- Jia-Jun Chen
- Department of Urology, Jinhua Municipal Central Hospital, JingHua, China.,Zhejiang University School of Medicine, HangZhou, China.,Department of Urology, ShaoXing People's Hosptial, ShaoXing, China
| | - Zai-Sheng Zhu
- Jinhua Municipal Central Hospital, Department of Urology, No. 365 Renmin East Road, Jinhua City, 321000, Zhejiang Province, China.
| | - Yi-Yi Zhu
- Zhejiang University School of Medicine, HangZhou, China
| | - Hong-Qi Shi
- Jinhua Municipal Central Hospital, Department of Pathology, JingHua, China
| |
Collapse
|
18
|
Caglic I, Panebianco V, Vargas HA, Bura V, Woo S, Pecoraro M, Cipollari S, Sala E, Barrett T. MRI of Bladder Cancer: Local and Nodal Staging. J Magn Reson Imaging 2020; 52:649-667. [PMID: 32112505 DOI: 10.1002/jmri.27090] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 12/24/2022] Open
Abstract
Accurate staging of bladder cancer (BC) is critical, with local tumor staging directly influencing management decisions and affecting prognosis. However, clinical staging based on clinical examination, including cystoscopy and transurethral resection of bladder tumor (TURBT), often understages patients compared to final pathology at radical cystectomy and lymph node (LN) dissection, mainly due to underestimation of the depth of local invasion and the presence of LN metastasis. MRI has now become established as the modality of choice for the local staging of BC and can be additionally utilized for the assessment of regional LN involvement and tumor spread to the pelvic bones and upper urinary tract (UUT). The recent development of the Vesical Imaging-Reporting and Data System (VI-RADS) recommendations has led to further improvements in bladder MRI, enabling standardization of image acquisition and reporting. Multiparametric magnetic resonance imaging (mpMRI) incorporating morphological and functional imaging has been proven to further improve the accuracy of primary and recurrent tumor detection and local staging, and has shown promise in predicting tumor aggressiveness and monitoring response to therapy. These sequences can also be utilized to perform radiomics, which has shown encouraging initial results in predicting BC grade and local stage. In this article, the current state of evidence supporting MRI in local, regional, and distant staging in patients with BC is reviewed. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY STAGE: 2 J. Magn. Reson. Imaging 2020;52:649-667.
Collapse
Affiliation(s)
- Iztok Caglic
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Valeria Panebianco
- Department of Radiological, Oncological and Anatomo-pathological sciences, "Sapienza University", Rome, Italy
| | - Hebert A Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Vlad Bura
- Department of Radiology, County Clinical Emergency Hospital, Cluj-Napoca, Romania
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Martina Pecoraro
- Department of Radiological, Oncological and Anatomo-pathological sciences, "Sapienza University", Rome, Italy
| | - Stefano Cipollari
- Department of Radiological, Oncological and Anatomo-pathological sciences, "Sapienza University", Rome, Italy
| | - Evis Sala
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| |
Collapse
|
19
|
[Usefulness of frozen section exams during radical cystectomy for urothelial carcinoma]. Prog Urol 2019; 30:51-57. [PMID: 31843294 DOI: 10.1016/j.purol.2019.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/12/2019] [Accepted: 09/28/2019] [Indexed: 11/22/2022]
Abstract
AIM To determine the usefulness of the frozen section exams of lymph nodes dissection, ureteral and urethral section during radical cystectomy for urothelial carcinoma and define the impact on the surgical procedure. METHOD A retrospective, single-center study of data collected from 182 patients who underwent radical cystectomy for an cT=3bN0M0 urothelial bladder cancer between 2016 and 2018. Bladder cancer extension was determined by thoracoabdominal CT with contrast enhancement and urography and an 18-FDG PET scanner. No patient received neoadjuvant chemotherapy. The diagnostic performance of the frozen section exams was related to final examinations. The impact of the result on the initial intervention was determined. RESULTS The frozen section were positive in 29 lymph nodes dissections (15.9 %), 59 (16.6 %) ureteral and 20 (10.9 %) ureteral recessions. With lymph nodes exams, sensitivity, specificity and positive and negative predictive values were 93.5 %, 100 %, 100 %, and 98.7 %, respectively. With ureteral sections exams the same values were 91.5 %, 100 %, 100 %, and 98.4 % respectively. With urethral section exams, all the values were of 100 %. Finally, all the procedure has been modified for all patients with positive frozen section exam except one positive urethral section that did not give rise to radical urethrectomy. CONCLUSION Frozen section exams were useful to the urologist during radical cystectomy for urothelial carcinoma. The performances of the frozen section exams carried out were excellent. The information of the urologist of the positive frozen section leeds to modify its management during the intervention in all the studied cases with the exception of one case.
Collapse
|
20
|
Perera M, McGrath S, Sengupta S, Crozier J, Bolton D, Lawrentschuk N. Pelvic lymph node dissection during radical cystectomy for muscle-invasive bladder cancer. Nat Rev Urol 2019; 15:686-692. [PMID: 30104615 DOI: 10.1038/s41585-018-0066-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Radical cystectomy is the gold-standard treatment option for muscle-invasive and metastatic bladder cancer. At the time of cystectomy, up to 25% of patients harbour metastatic lymph node deposits. These deposits most frequently occur in the obturator fossa, but can be as proximal as the interaortocaval region. Thus, the use of concurrent pelvic lymph node dissection (PLND) with cystectomy has been increasingly reported. Data from studies including many patients suggest substantial oncological benefit in PLND cohorts versus non-PLND cohorts, irrespective of pathological nodal status. Additionally, PLND provides useful prognostic information, including disease burden, lymph node density, and extracapsular extension of metastatic lymph nodes. Accordingly, the National Comprehensive Cancer Network guidelines advocate the use of PLND during radical cystectomy for muscle-invasive bladder cancer. Despite this recommendation, a lack of consensus exists regarding the optimal PLND template. Comparative series suggest that extended PLND provides improved recurrence-free survival and cancer-specific survival compared with more limited PLND templates. More extensive templates (such as super-extended PLND) provide no additional survival benefit at the potential cost of increased operative time and patient morbidity. In addition to extended PLND templates, increased nodal harvest confers an oncological benefit in patients with node-positive disease or in patients with node-negative disease. Accordingly, recommendations for a minimum nodal yield have been proposed. Despite the growing body of evidence, formal recommendations by oncological and urological authoritative bodies have been limited owing to the lack of randomized data and level I evidence.
Collapse
Affiliation(s)
- Marlon Perera
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.
| | - Shannon McGrath
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Shomik Sengupta
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Jack Crozier
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Damien Bolton
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.,Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia
| | - Nathan Lawrentschuk
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.,Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia.,Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| |
Collapse
|
21
|
Sharma M, Goto T, Yang Z, Miyamoto H. The impact of perivesical lymph node metastasis on clinical outcomes of bladder cancer patients undergoing radical cystectomy. BMC Urol 2019; 19:77. [PMID: 31419974 PMCID: PMC6697999 DOI: 10.1186/s12894-019-0507-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/02/2019] [Indexed: 12/24/2022] Open
Abstract
Background Perivesical lymph nodes (PVLNs) are occasionally isolated during grossing of cystectomy specimens. However, the prognostic implications of the involvement of PVLNs in bladder cancer patients, especially those with comparisons to pN0 disease, remain poorly understood. Methods A retrospective review identified 115 radical cystectomy cases where PVLNs had been histologically assessed. These cases were then divided into 4 groups – Group 1 (n = 76): PVLN-negative/other pelvic lymph node (non-PVLN)-negative; Group 2 (n = 5): PVLN-positive/non-PVLN-negative; Group 3 (n = 17): PVLN-negative/non-PVLN-positive; and Group 4 (n = 17): PVLN-positive/non-PVLN-positive. Results pT stage at cystectomy was significantly higher in Group 3 (P = 0.013), Group 4 (P < 0.001), Groups 2 and 4 (P < 0.001), or Groups 2–4 (P < 0.001) than in Group 1. However, the number of positive PVLNs (mean: 1.8 vs. 2.1; P = 0.718) or the rate of extracapsular extension in the PVLNs (40% vs. 65%, P = 0.609) was not significantly different between Group 2 and Group 4. Kaplan-Meier analysis and log-rank test revealed significantly (P < 0.05) higher risks of disease progression (Group 3/Group 4), cancer-specific mortality (Group 2/Group 3/Group 4), and overall mortality (Group 4), compared with Group 1. Multivariate analysis further showed metastasis to both PVLN and non-PVLN (Group 4), PVLN (Groups 2 and 4), or PVLN and/or non-PVLN (Groups 2–4) as an independent prognosticator for cancer-specific mortality and overall survival. There were also insignificant (P = 0.096) and significant (P = 0.036) differences in cancer-specific survival and overall survival, respectively, between Group 3 versus Group 4, and the trend of the latter was confirmed by subset multivariate analysis (hazard ratio = 3.769; P = 0.099). Conclusions Worse prognosis was observed in bladder cancer patients with isolated PVLN metastasis (vs. pN0 disease especially for cancer-specific survival), PVLN metastasis with or without non-PVLN metastasis (vs. pN0 disease), and concurrent PVLN and non-PVLN metastases (vs. PVLN-negative/non-PVLN-positive disease especially for overall survival). These findings indicate the importance of thorough histopathological assessment of PVLNs in radical cystectomy specimens.
Collapse
Affiliation(s)
- Meenal Sharma
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Takuro Goto
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA.,James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Zhiming Yang
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Hiroshi Miyamoto
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA. .,James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA. .,Department of Urology, University of Rochester Medical Center, Rochester, NY, USA.
| |
Collapse
|
22
|
Choi SY, You D, Hong B, Hong JH, Ahn H, Kim CS. Impact of lymph node dissection in radical cystectomy for bladder cancer: How many vs how far? Surg Oncol 2019; 30:109-116. [PMID: 31500772 DOI: 10.1016/j.suronc.2019.06.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/31/2019] [Accepted: 06/27/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To determine whether the extent or number of lymph nodes (LNs) is important in muscle-invasive bladder cancer and high-risk non-muscle-invasive bladder cancer patients' oncologic outcomes. METHODS A total of 448 patients who underwent radical cystectomy with lymphadenectomy of standard, extended, and super-extended template were included. Exclusion criteria were neoadjuvant chemotherapy and limited lymphadenectomy. Disease-free survival (DFS) including local recurrence and distant metastasis, cancer-specific survival (CSS), and overall survival (OS) were estimated using the Kaplan-Meier method. Cox hazard regression was applied to analyze risk factors. RESULTS Standard (n = 124), extended (n = 216), and super-extended group (n = 108) did not show significant differences in the estimated 5-year DFS, CSS and OS rates. On multivariate analysis, the number of removed LNs was a significant factor for distant metastasis-free (hazard ratio [HR] 0.981, p = 0.0222), CSS (HR 0.980, p = 0.0021) and OS (HR 0.984, p = 0.0032). However, the template was not significant in distant metastasis-free survival, CSS and OS. On Kaplan-Meier curve, the number of removed LN showed significant differences in DFS, CSS, and OS. In the subgroup of positive LNs, number of removed LNs was associated with favorable DFS (HR = 0.969, p = 0.0115), CSS (HR = 0.967, p = 0.0068) and OS (HR = 0.971, p = 0.0028). CONCLUSION The number of removed LNs was a more important factor for CSS and OS than the extent of lymphadenectomy. Meticulous and extended LN dissection can be helpful in controlling recurrence, and its survival benefit might be maximized in cases with positive LN. Meanwhile, the survival benefit of super-extended lymphadenectomy was limited for this patient population.
Collapse
Affiliation(s)
- Se Young Choi
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea
| | - Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Bumsik Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| |
Collapse
|
23
|
Gschwend JE, Heck MM, Lehmann J, Rübben H, Albers P, Wolff JM, Frohneberg D, de Geeter P, Heidenreich A, Kälble T, Stöckle M, Schnöller T, Stenzl A, Müller M, Truss M, Roth S, Liehr UB, Leißner J, Bregenzer T, Retz M. Extended Versus Limited Lymph Node Dissection in Bladder Cancer Patients Undergoing Radical Cystectomy: Survival Results from a Prospective, Randomized Trial. Eur Urol 2018; 75:604-611. [PMID: 30337060 DOI: 10.1016/j.eururo.2018.09.047] [Citation(s) in RCA: 171] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 09/26/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The extent of lymph node dissection (LND) in bladder cancer (BCa) patients at the time of radical cystectomy may affect oncologic outcome. OBJECTIVE To evaluate whether extended versus limited LND prolongs recurrence-free survival (RFS). DESIGN, SETTING, AND PARTICIPANTS Prospective, multicenter, phase-III trial patients with locally resectable T1G3 or muscle-invasive urothelial BCa (T2-T4aM0). INTERVENTION Randomization to limited (obturator, and internal and external iliac nodes) versus extended LND (in addition, deep obturator, common iliac, presacral, paracaval, interaortocaval, and para-aortal nodes up to the inferior mesenteric artery). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was RFS. Secondary endpoints included cancer-specific survival (CSS), overall survival (OS), and complications. The trial was designed to show 15% advantage of 5-yr RFS by extended LND. RESULTS AND LIMITATIONS In total, 401 patients were randomized from February 2006 to August 2010 (203 limited, 198 extended). The median number of dissected nodes was 19 in the limited and 31 in the extended arm. Extended LND failed to show superiority over limited LND with regard to RFS (5-yr RFS 65% vs 59%; hazard ratio [HR]=0.84 [95% confidence interval 0.58-1.22]; p=0.36), CSS (5-yr CSS 76% vs 65%; HR=0.70; p=0.10), and OS (5-yr OS 59% vs 50%; HR=0.78; p=0.12). Clavien grade ≥3 lymphoceles were more frequently reported in the extended LND group within 90d after surgery. Inclusion of T1G3 tumors may have contributed to the negative study result. CONCLUSIONS Extended LND failed to show a significant advantage over limited LND in RFS, CSS, and OS. A larger trial is required to determine whether extended compared with limited LND leads to a small, but clinically relevant, survival difference (ClinicalTrials.gov NCT01215071). PATIENT SUMMARY In this study, we investigated the outcome in bladder cancer patients undergoing cystectomy based on the anatomic extent of lymph node resection. We found that extended removal of lymph nodes did not reduce the rate of tumor recurrence in the expected range.
Collapse
Affiliation(s)
- Jürgen E Gschwend
- Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany.
| | - Matthias M Heck
- Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany
| | | | | | - Peter Albers
- Department of Urology, Heinrich Heine University, Düsseldorf, Germany
| | - Johannes M Wolff
- Department of Urology, Paracelsus Hospital Golzheim Düsseldorf, Düsseldorf, Germany
| | | | | | | | | | - Michael Stöckle
- Department of Urology, Saarland University Medical Center, Homburg, Germany
| | | | - Arnulf Stenzl
- Department of Urology, Eberhard Karls University, Tübingen, Germany
| | - Markus Müller
- Department of Urology, Hospital Ludwigshafen, Germany
| | | | - Stephan Roth
- Department of Urology, Helios Hospital, Wuppertal, Germany
| | - Uwe-Bernd Liehr
- Department of Urology, Otto von Guericke University, Magdeburg, Germany
| | | | | | - Margitta Retz
- Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany
| |
Collapse
|
24
|
Cattaneo F, Motterle G, Zattoni F, Morlacco A, Dal Moro F. The Role of Lymph Node Dissection in the Treatment of Bladder Cancer. Front Surg 2018; 5:62. [PMID: 30349822 PMCID: PMC6187970 DOI: 10.3389/fsurg.2018.00062] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 09/17/2018] [Indexed: 11/13/2022] Open
Abstract
Lymph node dissection (LND; PLND: pelvic LND) is an essential component of radical cystectomy (RC) for bladder cancer (BC). However, the optimal anatomical extent of LND and its potential therapeutic role are still controversial: as we will explain, the extent of LND dissection is a predictor of survival and local recurrence but what is an adequate extension is still unclear. Moreover, there is large uncertainty about the role of surgery in patients with clinically-positive nodes. In this review we will provide a synthesis of the available evidence on this highly debated topic. Overall, the studies presented in this work support the idea that extended lymphadenectomy could provide optimal diagnostic and possibly therapeutic results in cN- patients. In cN+ patients, post chemotherapy surgery may be considered especially in subjects who have a good response to CHT, although definitive evidence is still needed. Finally, the final results of randomized trials are eagerly awaited to draw definitive conclusions of the role of PLND in BC.
Collapse
Affiliation(s)
- Francesco Cattaneo
- Clinica Urologica, Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Università degli Studi di Padova, Padova, Italy
| | - Giovanni Motterle
- Clinica Urologica, Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Università degli Studi di Padova, Padova, Italy
| | - Filiberto Zattoni
- Clinica Urologica, Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Università degli Studi di Padova, Padova, Italy
| | - Alessandro Morlacco
- Clinica Urologica, Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Università degli Studi di Padova, Padova, Italy
| | - Fabrizio Dal Moro
- Clinica Urologica, Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Università degli Studi di Padova, Padova, Italy.,Clínica Urologica, Ospedale "Santa Maria della Misericordia", Università di Udine, Udine, Italy
| |
Collapse
|
25
|
The anatomical limits and oncological benefit of lymphadenectomy in muscle invasive bladder cancer. Actas Urol Esp 2017; 41:284-291. [PMID: 27498113 DOI: 10.1016/j.acuro.2016.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 07/13/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Lymphadenectomy is part of standard treatment for muscle invasive bladder cancer. The objective of this review is to provide an up-to-date review on the available scientific evidence in this field. ACQUISITION OF EVIDENCE We conducted a literature review in PubMed of relevant articles up to the present (2016). We found a systematic review published in 2014 that included the comparative studies published up to that year, and we updated the review with new relevant publications since that date. SYNTHESIS OF THE EVIDENCE The number of lymph nodes is not the best indicator for determining the quality of the lymphadenectomy given that the number can vary depending on numerous factors that depend not only on the surgeon but also on the patient and on the pathologist. The definition of standard anatomical territories and a meticulous extraction of the lymph nodes in these territories are more reproducible than the numbers of nodes removed. The optimal extension of lymphadenectomy is a topic of debate. The evidence published to date indicates that any extension of lymphadenectomy is better than not performing it, although it appears that limited lymphadenectomy is insufficient for the oncological control of the disease and that superextended lymphadenectomy provides no oncological benefit versus extended lymphadenectomy. CONCLUSIONS Despite a certain amount of controversy in terms of the optimal extension of lymphadenectomy, performing lymphadenectomy in all cases appears to be recommendable according to the available evidence. Extended lymphadenectomy provides greater oncological benefit than more limited dissections, while more extensive lymphadenectomies are not recommended.
Collapse
|
26
|
Lewis S, Murthy V, Mahantshetty U, Shrivastava SK. Incidental Dose to Pelvic Nodes in Bladder-Only Radiotherapy: Is It Clinically Relevant? Technol Cancer Res Treat 2017; 16:382-387. [PMID: 28168933 PMCID: PMC5616055 DOI: 10.1177/1533034617691409] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background and Purpose: Although there is a strong biological rationale to electively treat the pelvic nodes during bladder preservation, its clinical benefit is uncertain. This may be explained by the incidental dose received by the nodal regions when treating the bladder alone. This study was conducted to investigate the doses received by the different pelvic nodal regions when the bladder alone is treated by standard conformal radiotherapy. Methods and Materials: The computed tomography data sets of 20 patients with node-negative muscle-invasive bladder cancer treated in a bladder preservation protocol were studied. Patients were originally treated with conformal radiotherapy to the bladder alone. Replanning was done with additional delineation of the pelvic nodal regions namely common iliac (upper and lower), presacral, internal iliac, obturator, and external iliac. Dose volume parameters such as Dmean, Dmax, D100%, D66%, D33%, V40, and V50 to each of the nodal regions were estimated for all patients. Results: The obturator nodes received the highest dose among all nodal regions. The mean dose received by obturator, external iliac, and internal iliac regions was 59, 45, and 36 Gy, respectively. The dose received by these 3 regions in the full bladder state was 63, 52, and 47 Gy, respectively. The dose received by all other pelvic nodal regions was low and not clinically relevant. Conclusion: The incidental dose received by obturator and external iliac nodes is clinically significant in bladder-only radiation, possibly enough to influence micrometastatic disease. This may be a reason for the lack of clear benefit seen with nodal irradiation in bladder cancer. Advances in Knowledge: This study highlights that the incidental dose received by obturator and external iliac nodes is clinically significant in bladder-only radiation. The obturator nodes received the highest dose among all nodal regions with mean dose of 59 Gy.
Collapse
Affiliation(s)
- Shirley Lewis
- 1 Department of Radiation Oncology, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
| | - Vedang Murthy
- 1 Department of Radiation Oncology, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
| | - Umesh Mahantshetty
- 1 Department of Radiation Oncology, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
| | | |
Collapse
|
27
|
Hussein AA, Hinata N, Dibaj S, May PR, Kozlowski JD, Abol-Enein H, Abaza R, Eun D, Khan MS, Mohler JL, Agarwal P, Pohar K, Sarle R, Boris R, Mane SS, Hutson A, Guru KA. Development, validation and clinical application of Pelvic Lymphadenectomy Assessment and Completion Evaluation: intraoperative assessment of lymph node dissection after robot-assisted radical cystectomy for bladder cancer. BJU Int 2017; 119:879-884. [PMID: 27987527 DOI: 10.1111/bju.13748] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To develop a scoring tool, Pelvic Lymphadenectomy Appropriateness and Completion Evaluation (PLACE), to assess the intraoperative completeness and appropriateness of pelvic lymph node dissection (PLND) following robot-assisted radical cystectomy (RARC). PATIENTS, SUBJECTS AND METHODS A panel of 11 open and robotic surgeons developed the content and structure of PLACE. The PLND template was divided into three zones. In all, 21 de-identified videos of bilateral robot-assisted PLNDs were assessed by the 11 experts using PLACE to determine inter-rater reliability. Lymph node (LN) clearance was defined as the proportion of cleared LNs from all PLACE zones. We investigated the correlation between LN clearance and LN count. Then, we compared the LN count of 18 prospective PLNDs using PLACE with our retrospective series performed using the extended template (No PLACE). RESULTS A significant reliability was achieved for all PLACE zones among the 11 raters for the 21 bilateral PLND videos. The median (interquartile range) for LN clearance was 468 (431-545). There was a significant positive correlation between LN clearance and LN count (R2 = 0.70, P < 0.01). The PLACE group yielded similar LN counts when compared to the No PLACE group. CONCLUSIONS Pelvic Lymphadenectomy Appropriateness and Completion Evaluation is a structured intraoperative scoring system that can be used intraoperatively to measure and quantify PLND for quality control and to facilitate training during RARC.
Collapse
Affiliation(s)
- Ahmed A Hussein
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA.,Department of Urology, Cairo University, Cairo, Egypt
| | | | - Shiva Dibaj
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Paul R May
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | | | - Hassan Abol-Enein
- Department of Urology and Nephrology, Mansoura University, Mansoura, Egypt
| | | | - Daniel Eun
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Mohamed S Khan
- Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - James L Mohler
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | | | - Kamal Pohar
- Michigan Institute of Urology, Dearborn, MI, USA
| | | | - Ronald Boris
- Guy's and St Thomas' NHS Foundation Trust and King's College School of Medicine, London, UK
| | - Sridhar S Mane
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Alan Hutson
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Khurshid A Guru
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA
| |
Collapse
|
28
|
Radio-Guided Lymph Node Mapping in Bladder Cancer Using SPECT/CT and Intraoperative γ-Probe Methods. Clin Nucl Med 2017; 41:e362-7. [PMID: 27055134 DOI: 10.1097/rlu.0000000000001224] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Lymph outflow from bladder tumor differs between individuals, making the prediction of the metastatic landing sites difficult. A "blind" template of lymphadenectomy has been tested as a solution to this problem. We believe that it is feasible to find methods enabling more precise lymph nodes (LNs) evaluation. The aims of our study were to evaluate the possibility of LNs mapping in case of muscle invasive bladder cancer (MIBC) and to compare the 2 methods of their detection. PATIENTS AND METHODS Our study group consisted of 38 cN0 MIBC patients. Lymph nodes mapping was performed by SPECT/CT lymphoscintigraphy using Tc-nanocolloid, followed by intraoperative verification with γ-ray probe. Lymph nodes with increased radiotracer uptake (hot spots) were removed, and then pelvic LNs dissection was conducted. Lymph nodes resected as hot spots and LNs resected with lymphadenectomy were separately examined by a pathologist. RESULTS An average of 3 hot spots (range, 1-5) were identified in each case. For 36 of 38 patients, both preoperative SPECT/CT and intraoperative γ-probe evaluation results were obtained. Ninety-five percent of hot spots were found distally and caudally to the uretero-iliac crossing; 5% were found proximal. Lymph nodes outside the pelvic LNs dissection area did not contain metastases. In 2 patients, metastases were found in LNs without increased radiotracer uptake, and the observed hot spots contained no metastases. CONCLUSIONS Radio-guided LNs mapping in case of MIBC is feasible. Preoperative detection of hot spots using SPECT/CT and intraoperative γ-ray detection probe gives similar results.
Collapse
|
29
|
Aljabery F, Shabo I, Olsson H, Gimm O, Jahnson S. Radio-guided sentinel lymph node detection and lymph node mapping in invasive urinary bladder cancer: a prospective clinical study. BJU Int 2016; 120:329-336. [PMID: 27797436 DOI: 10.1111/bju.13700] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate the possibility of detecting sentinel lymph nodes (SNs) in patients with urinary bladder cancer (BCa) intra-operatively and whether the histopathological status of the identified SNs reflected that of the lymphatic field. PATIENTS AND METHODS We studied 103 patients with BCa pathological stage T1-T4 who were treated with cystectomy and pelvic lymph node (LN) dissection during 2005-2011 at the Department of Urology, Linköping University Hospital. Radioactive tracer Nanocoll 70 MBq and blue dye were injected into the bladder wall around the primary tumour before surgery. SNs were detected ex vivo during the operation with a handheld Geiger probe (Gamma Detection System; Neoprobe Corp., Dublin, OH, USA). All LNs were formalin-fixed, sectioned three times, mounted on slides and stained with haematoxylin and eosin. An experienced uropathologist evaluated the slides. RESULTS The mean age of the patients was 69 years, and 80 (77%) were male. Pathological staging was T1-12 (12%), T2-20 (19%), T3-48 (47%) and T4-23 (22%). A mean (range) number of 31 (7-68) nodes per patient were examined, totalling 3 253 nodes. LN metastases were found in 41 patients (40%). SNs were detected in 83 of the 103 patients (80%). Sensitivity and specificity for detecting metastatic disease by SN biopsy (SNB) varied between LN stations, with average values of 67% and 90%, respectively. LN metastatic density (LNMD) had a significant prognostic impact; a value of ≥8% was significantly related to shorter survival. Lymphovascular invasion (LVI) occurred in 65% of patients (n = 67) and was significantly associated with shorter cancer-specific survival (P < 0.001). CONCLUSION We conclude that SNB is not a reliable technique for peri-operative localization of LN metastases during cystectomy for BCa; however, LNMD has a significant prognostic value in BCa and may be useful in the clinical context and in BCa oncological and surgical research. LVI was also found to be a prognostic factor.
Collapse
Affiliation(s)
- Firas Aljabery
- Department of Urology, Region Östergötland, Linköping University Hospital, Linköping, Sweden.,Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, sweden
| | - Ivan Shabo
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, sweden.,Endocrine and Sarcoma Surgery Unit, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.,Department of Breast and Endocrine Surgery, Karolinska University Hospital, Solna Stockholm, Sweden
| | - Hans Olsson
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, sweden.,Department of Pathology, Region Östergötland, Linköping University Hospital, Linköping, Sweden
| | - Oliver Gimm
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, sweden.,Department of Surgery, Region Östergötland, Linköping University Hospital, Linköping, Sweden
| | - Staffan Jahnson
- Department of Urology, Region Östergötland, Linköping University Hospital, Linköping, Sweden.,Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, sweden
| |
Collapse
|
30
|
Takeuchi H, Tokuyama N, Kuroda I, Aoyagi T. Annular rectal constriction caused by infiltrating bladder cancer: A case report. Mol Clin Oncol 2016; 5:842-844. [PMID: 28105367 DOI: 10.3892/mco.2016.1047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 09/15/2016] [Indexed: 01/15/2023] Open
Abstract
A 69-year-old man was referred to our hospital with chief complaints of urinary incontinence, pollakiuria, thin stools and edema of the left lower extremity. Computed tomography and magnetic resonance imaging revealed bilateral hydronephrosis, thickening of the rectal and posterolateral bladder walls, and enlargement of the left obturator lymph nodes, suggesting metastasis. The carcinoembryonic antigen and carbohydrate antigen 19-9 levels were 5.6 ng/ml and 460.1 U/ml, respectively. A transurethral bladder biopsy revealed grade 2 urothelial carcinoma with glandular differentiation. A transrectal needle biopsy suggested cancer infiltration of the rectal wall and an annular rectal constriction caused by an infiltrating bladder cancer was diagnosed. Three courses of gemcitabine and cisplatin chemotherapy were administered and demonstrated good efficacy.
Collapse
Affiliation(s)
- Hisashi Takeuchi
- Department of Urology, Tokyo Medical University Ibaraki Medical Center, Ibaraki 300-0395, Japan
| | - Naoto Tokuyama
- Department of Urology, Tokyo Medical University Ibaraki Medical Center, Ibaraki 300-0395, Japan
| | - Isao Kuroda
- Department of Urology, Tokyo Medical University Ibaraki Medical Center, Ibaraki 300-0395, Japan
| | - Teiichiro Aoyagi
- Department of Urology, Tokyo Medical University Ibaraki Medical Center, Ibaraki 300-0395, Japan
| |
Collapse
|
31
|
Current Status of Lymph Node Imaging in Bladder and Prostate Cancer. Urology 2016; 96:1-7. [DOI: 10.1016/j.urology.2016.02.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/09/2016] [Accepted: 02/12/2016] [Indexed: 12/24/2022]
|
32
|
El-Hefnawy AS, Helmy T, Laimon M, El-Halwagy S, Abol-Enein H. Late intestinal obstruction after radical cystectomy and urinary diversion: urological and oncological perspectives. Scand J Urol 2016; 50:433-438. [DOI: 10.1080/21681805.2016.1204623] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ahmed S. El-Hefnawy
- Faculty of Medicine, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Tamer Helmy
- Faculty of Medicine, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mahmoud Laimon
- Faculty of Medicine, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Samer El-Halwagy
- Faculty of Medicine, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Hassan Abol-Enein
- Faculty of Medicine, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| |
Collapse
|
33
|
Cha EK, Thalmann GN, Bochner BH. Role of extended lymphadenectomy. Bladder Cancer 2015. [DOI: 10.1002/9781118674826.ch15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
34
|
Daneshmand S, Lerner SP. Radical cystectomy. Bladder Cancer 2015. [DOI: 10.1002/9781118674826.ch11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
35
|
Aljabery F, Lindblom G, Skoog S, Shabo I, Olsson H, Rosell J, Jahnson S. PET/CT versus conventional CT for detection of lymph node metastases in patients with locally advanced bladder cancer. BMC Urol 2015; 15:87. [PMID: 26294219 PMCID: PMC4546250 DOI: 10.1186/s12894-015-0080-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 08/05/2015] [Indexed: 03/12/2023] Open
Abstract
Background We studied patients treated with radical cystectomy for locally advanced bladder cancer to compare the results of both preoperative positron emission tomography/computed tomography (PET/CT) and conventional CT with the findings of postoperative histopathological evaluation of lymph nodes. Methods Patients who had bladder cancer and were candidates for cystectomy underwent preoperative PET/CT using 18-fluorodeoxyglucose (FDG) and conventional CT. The results regarding lymph node involvement were independently evaluated by two experienced radiologists and were subsequently compared with histopathology results, the latter of which were reassessed by an experienced uropathologist (HO). Results There were 54 evaluable patients (mean age 68 years, 47 [85 %] males and 7 [15 %] females) with pT and pN status as follows: < pT2-14 (26 %), pT2-10 (18 %), and > pT2-30 (56 %); pN0 37 (69 %) and pN+ 17 (31 %). PET/CT showed positive lymph nodes in 12 patients (22 %), and 7 of those cases were confirmed by histopathology; the corresponding results for conventional CT were 11 (20 %) and 7 patients (13 %), respectively. PET/CT had 41 % sensitivity, 86 % specificity, 58 % PPV, and 76 % NPV, whereas the corresponding figures for conventional CT were 41 %, 89 %, 64 %, and 77 %. Additional analyses of the right and left side of the body or in specified anatomical regions gave similar results. Conclusions In this study, PET/CT and conventional CT had similar low sensitivity in detecting and localizing regional lymph node metastasis in bladder cancer.
Collapse
Affiliation(s)
- Firas Aljabery
- Department of Urology, Linköping University Hospital, Linköping, Sweden. .,Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
| | - Gunnar Lindblom
- Department of Radiology, Linköping University Hospital, Linköping, Sweden.
| | - Susann Skoog
- Department of Radiology, Linköping University Hospital, Linköping, Sweden.
| | - Ivan Shabo
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
| | - Hans Olsson
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
| | - Johan Rosell
- Regional Cancer Center Southeast Sweden, County Council of Östergötland, Linköping, Sweden.
| | - Staffan Jahnson
- Department of Urology, Linköping University Hospital, Linköping, Sweden. .,Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
| |
Collapse
|
36
|
Editorial Comment. Urology 2015; 86:106-7. [PMID: 26142591 DOI: 10.1016/j.urology.2015.02.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
37
|
|
38
|
Ugurlu O, Baltaci S, Aslan G, Can C, Cal C, Elhan A, Turkeri L, Mungan A. Does skip metastasis or other lymph node parameters have additional effects on survival of patients undergoing radical cystectomy for bladder cancer? Korean J Urol 2015; 56:357-64. [PMID: 25964836 PMCID: PMC4426507 DOI: 10.4111/kju.2015.56.5.357] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 04/01/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose To investigate the effects of lymph node metastasis, skip metastasis, and other factors related to lymph node status on survival in patients who underwent radical cystectomy (RC) and extended lymph node dissection (eLND). Materials and Methods RC and eLND were performed in 85 patients with a diagnosis of bladder cancer. Disease-free survival (DFS) and overall survival (OS) were determined by using a Cox proportional hazards model that included the number of excised lymph nodes, the presence of pathological lymph node metastasis, the anatomical level of positive nodes, the number of positive lymph nodes, lymph node density, and the presence of skip metastasis. Results The mean number of lymph nodes removed per patient was 29.4±9.3. Lymph node positivity was detected in 85 patients (34.1%). The mean follow-up duration was 44.9±27.4 months (2-93 months). Five-year estimated OS and DFS for the 85 patients were 62.6% and 57%, respectively. Three of 29 lymph node-positive patients (10.3%) had skip metastasis. Only lymph node positivity had a significant effect on 5-year OS and DFS (p<0.001). No difference in OS and DFS was found between the three patients with skip metastasis and other lymph node-positive patients. Other factors related to lymph node status had no significant effect on 5-year OS and DFS. Conclusions No factors related to lymph node status predict DFS and OS, except for lymph node positivity. OS and DFS were comparable between patients with skip metastasis and other lymph node-positive patients.
Collapse
Affiliation(s)
- Ozgur Ugurlu
- Department of Urology, Private Akay Hospital, Ankara, Turkey
| | - Sumer Baltaci
- Department of Urology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Guven Aslan
- Department of Urology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Cavit Can
- Department of Urology, Eskişehir Osmangazi University Medical Faculty, Eskişehir, Turkey
| | - Cag Cal
- Department of Urology, Ege University Medical Faculty, Izmir, Turkey
| | - Atilla Elhan
- Department of Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Levent Turkeri
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Aydin Mungan
- Department of Urology, Karaelmas University, School of Medicine, Zonguldak, Turkey
| |
Collapse
|
39
|
Qin X, Zhang H, Wan F, Zhu Y, Shen Y, Dai B, Shi G, Zhu Y, Ye D. Retrograde radical cystectomy and consequent peritoneal cavity reconstruction benefits localized male bladder cancer: results from a cohort study. World J Surg Oncol 2015; 13:132. [PMID: 25886313 PMCID: PMC4382937 DOI: 10.1186/s12957-015-0561-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/23/2015] [Indexed: 01/28/2023] Open
Abstract
Background Bladder cancer is the second most common genitourinary malignancy. Our study was to introduce a standardized surgical procedure of retrograde radical cystectomy and consequent peritoneal cavity reconstruction in localized male bladder cancer. Methods Eighty-four consecutive male patients with localized bladder cancer (clinical stage T2 or lower) underwent surgery in our institute with the proposed procedure between May 2012 and April 2013. Median age was 65 years (range, 35 to 83 years); patient characteristics, surgical parameters, perioperative complications, pathology, and short-term prognosis were analyzed. Median follow-up was 24 months (range, 18 to 30 months). Results The complete procedure including urinary diversion took 4.0 h (2.2 to 5.0 h), with a median exposed peritoneal cavity of 45 min (0 to 75 min); the median blood loss was 140 ml (50 to 600 ml), and 2 patients needed transfusion; neurovascular bundles were reserved in 76 cases; the median abdominal and pelvic drainage was 9.0 days (6 to 15 days), the median gastrointestinal recovery was 2.5 days (1 to 12 days), and the median postoperative hospital stay was 13.0 days (10 to 21 days). Four patients had severe surgical complications, and two had mild to moderate ileus, with recovery in 1 and 2 weeks with supportive treatment. No perioperative deaths or postoperative recurrence were reported. Conclusions The surgical procedure in male localized bladder cancer described in the present study provided surgical facilities, with limited abdominal organ disturbance and satisfactory tumor control. The procedure was associated with good gastrointestinal recovery, few postoperative complications, and a short hospital stay.
Collapse
Affiliation(s)
- Xiaojian Qin
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong' an Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong' an Road, Shanghai, 200032, China.
| | - Hailiang Zhang
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong' an Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong' an Road, Shanghai, 200032, China.
| | - Fangning Wan
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong' an Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong' an Road, Shanghai, 200032, China.
| | - Yiping Zhu
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong' an Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong' an Road, Shanghai, 200032, China.
| | - Yijun Shen
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong' an Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong' an Road, Shanghai, 200032, China.
| | - Bo Dai
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong' an Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong' an Road, Shanghai, 200032, China.
| | - Guohai Shi
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong' an Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong' an Road, Shanghai, 200032, China.
| | - Yao Zhu
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong' an Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong' an Road, Shanghai, 200032, China.
| | - Dingwei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong' an Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong' an Road, Shanghai, 200032, China.
| |
Collapse
|
40
|
Liu W, Qi L, Lv H, Zu X, Chen M, Wang J, Liu L, Zeng F, Li Y. MiRNA-141 and miRNA-200b are closely related to invasive ability and considered as decision-making biomarkers for the extent of PLND during cystectomy. BMC Cancer 2015; 15:92. [PMID: 25884322 PMCID: PMC4350852 DOI: 10.1186/s12885-015-1110-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 02/20/2015] [Indexed: 11/10/2022] Open
Abstract
Background MicroRNAs (miRNAs) are small non-coding RNAs that silence their cognate target genes by specifically binding and cleaving messenger RNAs or inhibiting their translation. In this study, we explored whether miRNA-141 and miRNA-200b are involved in regulation of the invasive ability and epithelial–mesenchymal transition (EMT) of bladder cancer cells in vitro. We also evaluated their potential as biomarkers for deciding the extent of pelvic lymph node dissection (PLND) required during radical cystectomy. Methods Pri- and anti-miR cell lines were constructed. The invasive capacity of the cells was tested using a cell invasion assay. The MMP-2, MMP-9 and EMT-related markers were validated through Western blotting analysis. Seventy-eight urine samples from patients undergoing cystectomy and super-extended lymph node dissection were evaluated by qRT-PCR. Results Loss of expression of miRNA-141 and miRNA-200b was associated with increased invasion and migration ability, upregulated MMP-2, MMP-9, vimentin and N-cadherin expression, and downregulated E-cadherin expression in bladder cancer cell lines. Urine miRNA-141 and miRNA-200b levels could discriminate patients with lymph node metastasis from those who were lymph node negative (AUC: 0.704 and 0.674, respectively). Conclusion MiRNA-141 and miRNA-200b play important roles in the invasive ability and EMT phenotype of bladder cancer. Detection of miRNA-141 and miRNA-200b can help to identify patients undergoing cystectomy who are likely to have lymph node metastasis, and therefore those who may benefit from super-extended PLND. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1110-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Wentao Liu
- Department of Urology, Xiangya Hospital, Central South University, No.87 Xiangya Road, Changsha City, Hunan Province, 410008, P. R. China. .,Present address: Department of Urology, The second Xiangya Hospital, Central South University, Changsha City, Hunan Province, P. R. China.
| | - Lin Qi
- Department of Urology, Xiangya Hospital, Central South University, No.87 Xiangya Road, Changsha City, Hunan Province, 410008, P. R. China.
| | - Hui Lv
- Department of Pathology, Xiangya School of Medicine, Central South University, Changsha City, Hunan Province, P. R. China.
| | - Xiongbing Zu
- Department of Urology, Xiangya Hospital, Central South University, No.87 Xiangya Road, Changsha City, Hunan Province, 410008, P. R. China.
| | - Minfeng Chen
- Department of Urology, Xiangya Hospital, Central South University, No.87 Xiangya Road, Changsha City, Hunan Province, 410008, P. R. China.
| | - Jun Wang
- Department of Urology, First Teaching Hospital, Zhengzhou University, Zhengzhou City, Henan Province, P. R. China.
| | - Longfei Liu
- Department of Urology, Xiangya Hospital, Central South University, No.87 Xiangya Road, Changsha City, Hunan Province, 410008, P. R. China.
| | - Feng Zeng
- Department of Urology, Xiangya Hospital, Central South University, No.87 Xiangya Road, Changsha City, Hunan Province, 410008, P. R. China.
| | - Yuan Li
- Department of Urology, Xiangya Hospital, Central South University, No.87 Xiangya Road, Changsha City, Hunan Province, 410008, P. R. China.
| |
Collapse
|
41
|
Cha EK, Donahue TF, Bochner BH. Radical transurethral resection alone, robotic or partial cystectomy, or extended lymphadenectomy: can we select patients with muscle invasion for less or more surgery? Urol Clin North Am 2015; 42:189-99, viii. [PMID: 25882561 DOI: 10.1016/j.ucl.2015.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Improvements in the accuracy of clinical staging and refinements in patient selection may allow for improved outcomes of bladder-preservation strategies for muscle-invasive bladder cancer incorporating radical transurethral resection (TUR) and partial cystectomy (PC). Retrospective studies of patients treated with radical cystectomy and pelvic lymph node dissection have reported an association between greater extent of lymphadenectomy and improved clinical outcomes. However, there is no consensus regarding the optimal extent of lymphadenectomy, as there are currently no reports from prospective, randomized trials to address this issue in regards to cancer-specific and overall survival. Future advances in the understanding of the appropriate extent of lymphadenectomy requires well-designed prospective clinical trials that directly compare varying extents of surgery with their ability to provide local and distant disease control and disease-specific survival.
Collapse
Affiliation(s)
- Eugene K Cha
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 353 East 68th Street, New York, NY 10065, USA
| | - Timothy F Donahue
- Center for Prostate Disease Research, Uniformed Services University, 1530 East Jefferson Street, Rockville, MD 20852, USA; John P. Murthy Cancer Center, Urology Service, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889, USA
| | - Bernard H Bochner
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 353 East 68th Street, New York, NY 10065, USA.
| |
Collapse
|
42
|
Novel Bladder Preservation Therapy with Osaka Medical College Regimen. J Urol 2015; 193:443-50. [DOI: 10.1016/j.juro.2014.08.094] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2014] [Indexed: 11/20/2022]
|
43
|
Bruins HM, Veskimae E, Hernandez V, Imamura M, Neuberger MM, Dahm P, Stewart F, Lam TB, N’Dow J, van der Heijden AG, Compérat E, Cowan NC, De Santis M, Gakis G, Lebret T, Ribal MJ, Sherif A, Witjes JA. The Impact of the Extent of Lymphadenectomy on Oncologic Outcomes in Patients Undergoing Radical Cystectomy for Bladder Cancer: A Systematic Review. Eur Urol 2014; 66:1065-77. [DOI: 10.1016/j.eururo.2014.05.031] [Citation(s) in RCA: 133] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 05/21/2014] [Indexed: 12/15/2022]
|
44
|
Abe T, Takada N, Matsumoto R, Osawa T, Sazawa A, Maruyama S, Tsuchiya K, Harabayashi T, Minami K, Nagamori S, Hatanaka KC, Tanaka Y, Shinohara N, Nonomura K. Outcome of regional lymphadenectomy in accordance with primary tumor location on laparoscopic nephroureterectomy for urothelial carcinoma of the upper urinary tract: a prospective study. J Endourol 2014; 29:304-9. [PMID: 25255401 DOI: 10.1089/end.2014.0369] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE To determine the appropriate template of regional lymph node dissection (LND) at the time of laparoscopic nephroureterectomy (LNU) for patients with clinically node- negative urothelial carcinoma of the upper urinary tract. PATIENTS AND METHODS This prospective study included 45 patients undergoing LND with LNU in accordance with our prospective rules regarding the area of LND. Perioperative, pathologic, and follow-up data were collected. Micrometastasis in lymph nodes (LNs) was later evaluated by immunohistochemistry (IHC). Recurrence-free survival (RFS) was calculated with the Kaplan-Meier method. RESULTS The median number of LNs removed was 14 (range 1-33). One patient with pT3 disease had node metastasis based on routine pathologic examination, and IHC revealed micrometastases in two additional patients (pT2 in one and pT3 in one). Therefore, 15% (3/20) of patients with ≥pT2 disease had node disease. After surgery, six patients experienced minor complications (Grade 1 or 2), and Grade 5 gastrointestinal bleeding after aspiration pneumonia developed in one elderly male patient on the 45th postoperative day, which was not considered to be associated with LND. At the last follow-up, lung metastasis developed in four patients (pT1 in one, pT2 in one, and pT3 in two), and presacral lymph node metastasis developed in one patient with a lower ureteral tumor (pT2), which was not included in our prospective template for a lower ureteral tumor. LN recurrence within/ near the LND area was not observed in patients with pelvic/upper ureteral carcinoma. The 2-year nonurothelial RFS rate was 84%. CONCLUSIONS We consider that the present template represents regional LNs for patients with clinically node-negative pelvic/upper ureteral carcinoma, while presacral LNs may be incorporated into the regional LND template for patients with clinically node-negative lower ureteral carcinoma.
Collapse
Affiliation(s)
- Takashige Abe
- 1 Department of Urology, Hokkaido University Graduate School of Medicine , Sapporo, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Hu B, Satkunasivam R, Schuckman A, Sherrod A, Cai J, Miranda G, Daneshmand S. Significance of perivesical lymph nodes in radical cystectomy for bladder cancer. Urol Oncol 2014; 32:1158-65. [DOI: 10.1016/j.urolonc.2014.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 07/25/2014] [Accepted: 08/13/2014] [Indexed: 10/24/2022]
|
46
|
|
47
|
Kwon T, Jeong IG, Lee J, Lee C, You D, Hong B, Hong JH, Ahn H, Kim CS. Adjuvant chemotherapy after radical cystectomy for bladder cancer: a comparative study using inverse-probability-of-treatment weighting. J Cancer Res Clin Oncol 2014; 141:169-76. [PMID: 25119986 DOI: 10.1007/s00432-014-1793-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 08/03/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The role of adjuvant chemotherapy (AC) after radical cystectomy for bladder cancer remains unclear. This study evaluated the benefits of cisplatin-based AC plus surgery versus surgery alone in patients with bladder cancer. MATERIALS AND METHODS The medical records of 746 patients who underwent radical cystectomy for bladder cancer were reviewed. The association between AC and survival was analyzed using Cox regression models. To reduce the impact of treatment selection bias and potential confounding in an observational study, significant differences in patient characteristics were rigorously adjusted using inverse-probability-of-treatment weighting (IPTW). RESULTS The cohort consisted of 746 patients (664 men and 82 women) of mean age 62.4 years and median follow-up of 64.3 months (range, 1-231.4 months). Of these patients, 176 (23.6%) received AC after cystectomy and 570 (76.4%) underwent cystectomy alone. Patients who received AC were significantly younger (60 vs. 63 years, p = 0.001) and significantly more likely to have high pathologic T stage (p = 0.001), lymph node metastasis (p = 0.001), high grade (p = 0.001), and lymphovascular invasion (p = 0.001) than patients who underwent cystectomy alone. Multivariable analysis showed a cancer-specific survival (CSS) benefit for AC [hazard ratio (HR) 0.56, 95% confidence interval (CI) 0.39-0.80, p = 0.002], as did low pathologic T stage, absence of lymph node metastasis, and absence of lymphovascular invasion. After IPTW adjustment for baseline characteristics, AC remained an independent predictor of CSS (HR 0.83, 95% CI 0.69-0.99, p = 0.043). CONCLUSIONS Cisplatin-based AC after radical cystectomy had survival benefits in patients with bladder cancer, even after IPTW adjustment for confounding variables.
Collapse
Affiliation(s)
- Taekmin Kwon
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap 2 dong Songpa-gu, Seoul, 138-736, Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Raza SJ, Field E, Kibel AS, Mottrie A, Weizer AZ, Wagner A, Hemal AK, Scherr DS, Schanne F, Gaboardi F, Wu G, Peabody JO, Koauk J, Redorta JP, Pattaras JG, Rha KH, Richstone L, Balbay MD, Menon M, Hayn M, Stoeckle M, Wiklund P, Dasgupta P, Pruthi R, Ghavamian R, Khan S, Siemer S, Maatman T, Wilson T, Poulakis V, Wilding G, Guru KA. International Robotic Radical Cystectomy Consortium: A way forward. Indian J Urol 2014; 30:314-7. [PMID: 25097319 PMCID: PMC4120220 DOI: 10.4103/0970-1591.134253] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Robot-assisted radical cystectomy (RARC) is an emerging operative alternative to open surgery for the management of invasive bladder cancer. Studies from single institutions provide limited data due to the small number of patients. In order to better understand the related outcomes, a world-wide consortium was established in 2006 of patients undergoing RARC, called the International Robotic Cystectomy Consortium (IRCC). Thus far, the IRCC has reported its findings on various areas of operative interest and continues to expand its capacity to include other operative modalities and transform it into the International Radical Cystectomy Consortium. This article summarizes the findings of the IRCC and highlights the future direction of the consortium.
Collapse
Affiliation(s)
- Syed Johar Raza
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Erinn Field
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Adam S Kibel
- Washington University School of Medicine, St. Louis, MO, USA
| | - Alex Mottrie
- Deaprtment of Urology, Onze-Lieve-Vrouw Ziekenhuis, Aalast, Belgium
| | | | - Andrew Wagner
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ashok K Hemal
- Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | | | | | | | - Guan Wu
- University of Rochester Medical Center, Rochester, NY
| | | | - Jihad Koauk
- Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | | | - Koon-Ho Rha
- Yonsei University Health System Severance Hospital, Seoul, Korea
| | - Lee Richstone
- The Arthur Smith Institute for Urology, New York, NY, USA
| | | | - Mani Menon
- Henry Ford Health System, Detroit, MI, USA
| | | | | | | | - Prokar Dasgupta
- Guy's Hospital and King's College London School of Medicine, London, UK
| | - Raj Pruthi
- University of North Carolina, Wilmington, NC, USA
| | | | - Shamim Khan
- Guy's Hospital and King's College London School of Medicine, London, UK
| | | | | | | | | | - Greg Wilding
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Khurshid A Guru
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA
| |
Collapse
|
49
|
Bi L, Huang H, Fan X, Li K, Xu K, Jiang C, Liu H, Dong W, Zhang S, Yang X, Lin T, Huang J. Extended vs non-extended pelvic lymph node dissection and their influence on recurrence-free survival in patients undergoing radical cystectomy for bladder cancer: a systematic review and meta-analysis of comparative studies. BJU Int 2014; 113:E39-48. [DOI: 10.1111/bju.12371] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Liangkuan Bi
- Department of Urology; Sun Yat-sen Memorial Hospital, Sun Yat-sen University
- Key Laboratory of Malignant Tumour Gene Regulation and Target Therapy of Guangdong Higher Education Institutes; Sun Yat-sen University; Guangzhou China
| | - Hai Huang
- Department of Urology; Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Xinxiang Fan
- Department of Urology; Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Kaiwen Li
- Department of Urology; Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Kewei Xu
- Department of Urology; Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Chun Jiang
- Department of Urology; Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Hao Liu
- Department of Urology; Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Wen Dong
- Department of Urology; Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Simin Zhang
- Department of Urology; Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Xiangyun Yang
- Department of Urology; Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Tianxin Lin
- Department of Urology; Sun Yat-sen Memorial Hospital, Sun Yat-sen University
- Key Laboratory of Malignant Tumour Gene Regulation and Target Therapy of Guangdong Higher Education Institutes; Sun Yat-sen University; Guangzhou China
| | - Jian Huang
- Department of Urology; Sun Yat-sen Memorial Hospital, Sun Yat-sen University
- Key Laboratory of Malignant Tumour Gene Regulation and Target Therapy of Guangdong Higher Education Institutes; Sun Yat-sen University; Guangzhou China
| |
Collapse
|
50
|
AZUMA HARUHITO, INAMOTO TERUO, TAKAHARA KIYOSHI, NOMI HAYAHITO, HIRANO HAJIME, IBUKI NAOKAZU, UEHARA HIROSHI, KOMURA KAZUMASA, MINAMI KOICHIRO, UCHIMOTO TAIZO, SAITO KENKICHI, TAKAI TOMOAKI, TANDA NAOKI, YAMAMOTO KAZUHIRO, NARUMI YOSHIHUMI, KIYAMA SATOSHI. The novel bladder preservation therapy BOAI-CDDP-radiation (OMC-regimen): A new treatment option for invasive bladder cancer patients with lymph node metastasis. Int J Oncol 2014; 44:1895-903. [DOI: 10.3892/ijo.2014.2378] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 03/17/2014] [Indexed: 11/06/2022] Open
|