Presentation Authors: GANESH BAKSHI, Mahendra Pal, Gagan Prakash*, Ashwin Tamhankar, MUMBAI, India
Introduction: A good pelvic lymph node dissection (PLND) during radical cystectomy (RC) is a standard of practice. Although the extent of PLND is debatable, the progression-free survival and overall survival have been correlated with the number of nodes removed during surgery. The sentinel marker of lymph node dissection which is the lymph node density (LNd) is not used in routine practice as a prognostic variable.ObjectiveTo evaluate the prognostic value of LNd in Ca Bladder and to evaluate a cut off value of LNd that correlates with prognosis and survival for patients undergoing RC+PLND.
Methods: The records of patients undergoing upfront RC + PLND over consecutive five years in a cancer institute, were analysed retrospectively excluding those who received neoadjuvant chemotherapy or treatment failures following bladder conservation therapy.
Results: A total of 152 patients were analysed (M:F 139:13) with median age of 62 years. 76 (50.7%) were found to have nodal metastasis out of which 34 were found to have perinodal extension. 59 (77.6%) received adjuvant chemotherapy and 16 (21.1%) received postoperative radiotherapy. One patient was given postoperative chemo-radiation. At median follow up of 60 months, 47 of the 150 patients had died of the disease. The median lymph nodes yield was 17 (6-36). On univariate analysis number of lymph nodes dissected did not correlate with survival. However pT stage, presence of perinodal extension and LNd were all found to affect survival significantly in both univariate and multivariate analysis with a hazard ratio of 3.23 for perinodal extension. LNd of less than 10% did not correlate with survival but a range between 10-20% and > 20% showed a hazard ratio of 3.9 and 6.6 respectively. The mean survival for patients with node negative disease was 109 months which reduced to 24 months amongst patients with LNd of > 0.21. LNd cut-off value of 15% was found to be most relevant and applicable for survival.
Conclusions: Lymph node density is the one of strongest predictor of overall survival in urinary bladder cancer. A proposed lymph node density threshold of 15% correlates well with recurrence and survival and for prognostication.