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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Pathologic nodal staging score for bladder cancer: A decision tool for adjuvant therapy after radical cystectomy
European Urology, Volume 63, No. 2, Year 2013
Notification
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Description
Background: Radical cystectomy (RC) with pelvic lymph node dissection (PLND) is the standard of care for high-risk non-muscle-invasive and muscle-invasive bladder cancer (BCa). Objective: To develop a model that allows quantification of the likelihood that a pathologically node-negative patient has, indeed, no positive nodes. Design, setting, and participants: We analyzed data from 4335 patients treated with RC and PLND without neoadjuvant chemotherapy at 12 international academic centers. Interventions: Patients underwent RC and PLND. Outcome measurements and statistical analysis: We estimated the sensitivity of pathologic nodal staging using a beta-binomial model and developed a pathologic (postoperative) nodal staging score (pNSS) that represents the probability that a patient is correctly staged as node negative as a function of the number of examined nodes. Results and limitations: Overall, the probability of missing a positive node decreases with the increasing number of nodes examined (52% if 3 nodes are examined, 40% if 5 are examined, and 26% if 10 are examined). The proportion of having a positive node increased proportionally with advancing pathologic T stage and lymphovascular invasion (LVI). Patients with LVI who had 25 examined nodes would have a pNSS of 80% (pT1), 88% (pT2), and 66% (pT3-T4), whereas 10 examined nodes were sufficient for pNSS exceeding 90% in patients without LVI and pT0-T2 tumors. This study is limited because of its retrospective design and multicenter nature. Conclusions: We developed a tool that estimates the likelihood of lymph node (LN) metastasis in BCa patients treated with RC by evaluating the number of examined nodes, the pathologic T stage, and LVI. The pNSS indicates the adequacy of nodal staging in LN-negative patients. This tool could help to refine clinical decision making regarding adjuvant chemotherapy, follow-up scheduling, and inclusion in clinical trials. © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Authors & Co-Authors
Shariat, Shahrokh F.
United States, New York
New York Presbyterian Hospital
Rink, Michael
United States, New York
New York Presbyterian Hospital
Germany, Hamburg
Universitätsklinikum Hamburg-eppendorf
Ehdaie, Behfar
United States, New York
New York Presbyterian Hospital
Xylinas, Évanguelos N.
United States, New York
New York Presbyterian Hospital
France, Paris
Hopital Cochin Ap-hp
Babjuk, Marek M.
Czech Republic, Prague
Charles University
Merseburger, Alex S.
Germany, Hannover
Hannover Medical School
Svatek, Robert S.
United States, San Antonio
University of Texas Health Science Center at San Antonio
Cha, Eugene K.
United States, New York
New York Presbyterian Hospital
Tagawa, Scott
United States, New York
New York Presbyterian Hospital
Fajkovic, Harun
United States, New York
New York Presbyterian Hospital
Austria
General Hospital St. Poelten
Novara, Giacomo
Italy, Padua
Università Degli Studi Di Padova
I. Karakiewicz, Pierre I.
Canada, Montreal
University of Montreal
Trinh, Q. D.
Canada, Montreal
University of Montreal
Daneshmand, Siamak
United States, Los Angeles
University of Southern California
Lotan, Yair R.
United States, Dallas
Ut Southwestern Medical Center
Kassouf, Wassim
Canada, Montreal
Centre Universitaire de Santé Mcgill
Fritsche, Hans Martin
Germany, Regensburg
Universität Regensburg
Chun, Felix K.
Germany, Hamburg
Universitätsklinikum Hamburg-eppendorf
Sonpavde, Guru P.
United States, Houston
Baylor College of Medicine
Joual, Abdennabi
Morocco, Casablanca
Centre Hospitalier Universitaire Ibn Rochd
Scherr, Douglas S.
United States, New York
New York Presbyterian Hospital
Gönen, Mithat
United States, New York
Memorial Sloan-kettering Cancer Center
Statistics
Citations: 48
Authors: 22
Affiliations: 16
Identifiers
Doi:
10.1016/j.eururo.2012.06.008
ISSN:
03022838
Research Areas
Cancer
Health System And Policy
Study Design
Cohort Study
Study Approach
Quantitative