Clinical outcomes and recurrence predictors of lymph node positive urothelial cancer after cystectomy. The impact of primary stage on survival in patients with lymph node positive bladder cancer. Critical analysis and validation of lymph node density as prognostic variable in urothelial carcinoma of bladder. Lymph node density as a prognostic variable in node-positive bladder cancer: a meta-analysis. Cancer survival and prevalence in Australia: period estimates from 1982 to 2010. European Association of Urology (2016).Īustralian Institute of Health Welfare. EAU guidelines on muscle-invasive and metastatic bladder cancer. 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. Accordingly, recommendations for a minimum nodal yield have been proposed. 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. More extensive templates (such as super-extended PLND) provide no additional survival benefit at the potential cost of increased operative time and patient morbidity.
Pelvic lymph nodes series#
Comparative series suggest that extended PLND provides improved recurrence-free survival and cancer-specific survival compared with more limited PLND templates.
Despite this recommendation, a lack of consensus exists regarding the optimal PLND template. Accordingly, the National Comprehensive Cancer Network guidelines advocate the use of PLND during radical cystectomy for muscle-invasive bladder cancer. Additionally, PLND provides useful prognostic information, including disease burden, lymph node density, and extracapsular extension of metastatic lymph nodes. Data from studies including many patients suggest substantial oncological benefit in PLND cohorts versus non-PLND cohorts, irrespective of pathological nodal status. Thus, the use of concurrent pelvic lymph node dissection (PLND) with cystectomy has been increasingly reported. These deposits most frequently occur in the obturator fossa, but can be as proximal as the interaortocaval region. At the time of cystectomy, up to 25% of patients harbour metastatic lymph node deposits. Radical cystectomy is the gold-standard treatment option for muscle-invasive and metastatic bladder cancer.
0 kommentar(er)
