Not all lymph node-positive bladder cancers carry poor prognosis

NEW YORK (Reuters Health) - There is a real difference in survival for patients with bladder cancer involving one or two lymph nodes compared to those who have three or more lymph nodes involved, clinicians report in the November issue of the Journal of Urology.

"But the only way to be sure that patients have 'low-volume disease' is to do a full lymph node dissection and to ensure that the pathologist reviews the lymph nodes carefully and systematically," study co-author Dr. David F. Penson, of Vanderbilt University, Nashville, told Reuters Health.

"If a clinician performs a limited lymph node dissection (similar to that performed for a prostatectomy), there is not enough sampling to really ensure that the patient has low-risk disease," he added.

Dr. Penson and colleagues at the Keck School of Medicine, University of Southern California, Los Angeles, analyzed clinical outcomes and recurrence predictors of lymph node-positive urothelial cancer after cystectomy. Of 369 patients, 181 had only 1 or 2 lymph nodes involved, while 188 had 2 or more involved lymph nodes.

According to the researchers, estimated 5- and 10-year recurrence-free survival rates in patients with low-volume lymph node metastasis was 43.8% and 40.9%, respectively, significantly better than in patients with more than 2 positive lymph nodes (p < 0.001). Those with more than 2 positive lymph nodes had recurrence-free survival rates of about 20 percent at 5 and 10 years.

"Not all patients with lymph node positive bladder cancer are created equal -- the number of lymph nodes involved makes a difference," Dr. Penson noted.

On multivariate analysis, pathological tumor subgroup, adjuvant chemotherapy and lymph node density at a 4% cutoff were independently associated with time to recurrence and overall survival.

Five- and 10-year recurrence-free survival in 113 patients with lymph node density at 4% or less was 52% and 50%. That compared to 5-year recurrence-free survival of 29% and 10-year recurrence-free survival of 26% in 68 patients with lymph node density greater than 4%.

Dr. Penson said their findings also indicate that patients who have low-volume lymph node involvement "appear to derive a real benefit from adjuvant or neoadjuvant chemotherapy and clinicians should not hesitate to give chemotherapy to these patients."

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