To investigate the staging of lymphadenectomy during radical cystectomy (RC) due to bladder cancer (BCa). No data exists about the possibility to limit the extension of pelvic lymph node dissection (PLND) on the basis of preoperative or intraoperative parameters without losing accuracy in the staging procedure.
Between 1995 and 2012, 1,016 RC due to BCa were performed at a single tertiary care institution. The relationship between the number of nodes removed and the probability to find node metastases at final pathology examination was assessed using receiver operating characteristic (ROC) analyses.
Among the patients who underwent RC plus PLND, the lymph node metastases (LNM) prevalence was 35. 7% (363 of 1,016). ROC curve analyses were used to explore graphically the relationship between the numbers of removed and examined nodes and the probability of finding one or more metastatic nodes in the overall population. The curve indicated that 25, 35 and 45 nodes need to be removed to achieve 75, 90% and 95% probability respectively of detecting one or more LNM. When the analyses were stratified according to preoperative characteristics, only slight differences were recorded among the sensitivity analyses stratified for pathological stage, primary or progressive status or radiological N status.
Our results shown that is necessary to extend PLND in order to improve the ability to stage accurately node metastases. Preoperative parameters can minimally change this indication and an extended PLND should be always performed.
Urology. 2015 Dec 09 [Epub ahead of print]
Marco Moschini, R Jeffrey Karnes, Giorgio Gandaglia, Stefano Luzzago, Paolo Dell'Oglio, Martina Sofia Rossi, Ettore di Trapani, Giovanni La Croce, Rocco Damiano, Andrea Salonia, Shahrokh F Shariat, Francesco Montorsi, Alberto Briganti, Andrea Gallina, Renzo Colombo
Unit of Urology/Division of Oncology; IRCCS Ospedale San Raffaele; URI Milan, Italy; Department of Urology, Mayo Clinic, Rochester, MN, USA; Department of Urology, Magna Graecia University of Catanzaro, Doctorate Research Program, Catanzaro, Italy. Department of Urology, Mayo Clinic, Rochester, MN, USA. , Unit of Urology/Division of Oncology; IRCCS Ospedale San Raffaele; URI Milan, Italy. , Unit of Urology/Division of Oncology; IRCCS Ospedale San Raffaele; URI Milan, Italy. , Unit of Urology/Division of Oncology; IRCCS Ospedale San Raffaele; URI Milan, Italy. , Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy. , Unit of Urology/Division of Oncology; IRCCS Ospedale San Raffaele; URI Milan, Italy. , Unit of Urology/Division of Oncology; IRCCS Ospedale San Raffaele; URI Milan, Italy. , Department of Urology, Magna Graecia University of Catanzaro, Doctorate Research Program, Catanzaro, Italy. , Unit of Urology/Division of Oncology; IRCCS Ospedale San Raffaele; URI Milan, Italy. , Department of Urology, Medical University of Vienna, Vienna, Austria. , Unit of Urology/Division of Oncology; IRCCS Ospedale San Raffaele; URI Milan, Italy. , Unit of Urology/Division of Oncology; IRCCS Ospedale San Raffaele; URI Milan, Italy. , Unit of Urology/Division of Oncology; IRCCS Ospedale San Raffaele; URI Milan, Italy. , Unit of Urology/Division of Oncology; IRCCS Ospedale San Raffaele; URI Milan, Italy.