BERKELEY, CA (UroToday.com) - Lymph node density is a surrogate marker of the extent (i.e. 'quality') of lymph node dissection during radical cystectomy and impacts patient outcome.

There is a growing body of literature which suggests that the quality of a lymph node dissection radical cystectomy for bladder cancer is a predictor of recurrence-free survival of patients with node positive bladder cancer after cystectomy involvement. However, the 'ideal template' for pelvic node dissections is not standardized and there is a wide variation in extent of dissection.

A surrogate marker of quality of node dissection is lymph node density - defined as the ratio (percentage) of the number of positive nodes divided by the total number of nodes examined.

In the April issue of Journal of Urology, Herr presents data from 5 studies on a total of 979 patients. In 4 studies, higher lymph node density (> 25 or 25%) was a significant predictive factor for survival when adjusted for various patient, tumor and treatment co variables. This remained true even when adjuvant chemotherapy was accounted for, in the one study which examined the same.

What is also worth noting from the article is that the range of lymph nodes removed, even in academic centers, can be as few as 1 to as many as 96. Amazingly, data from the SEER registry suggest that, across the country, as many as 40% patients do not undergo a lymph node dissection at all.

While the ideal situation would be to have a standardized template which all can agree upon, this is likely to prove difficult to 'regulate'. Lymph node number (and density) is more objective data which can be used to not only risk stratify patients more appropriately, but also serve as a surrogate marker for quality of surgical dissection.

Herr HW

J Urol. 2007 Apr; 177(4):1273-5

UroToday.com Bladder Cancer Section

Written by Ashish M. Kamat, a Contributing Editor with UroToday.

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