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Lymph Node Density Is Superior to TNM Nodal Status in Predicting Disease-Specific Survival After Radical Cystectomy for Bladder Cancer: Analysis of Pooled Data From MDACC and MSKCC

Wassim Kassouf, Piyush K. Agarwal, Harry W. Herr, Mark F. Munsell, Philippe E. Spiess, Gordon A. Brown, Louis Pisters, H. Barton Grossman, Colin P. Dinney, Ashish M. Kamat

From the Department of Urology and the Division of Quantitative Sciences, The University of Texas M.D. Anderson Cancer Center, Houston, TX; and the Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY

Corresponding author: Ashish M. Kamat, MD, Department of Urology, Unit 1373, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; e-mail: akamat{at}mdanderson.org

Purpose To compare the utility of lymph node density (LND) with TNM nodal status in predicting disease-specific survival (DSS) after radical cystectomy.

Patients and Methods We identified 248 patients with nodal metastasis after radical cystectomy (without neoadjuvant chemotherapy): 162 patients from Memorial Sloan-Kettering Cancer Center (MSKCC) and 86 patients from M.D. Anderson Cancer Center (MDACC). We assessed the effect of several variables on DSS.

Results After a median follow-up duration of 24 months, 134 patients died of their disease. The median DSS was 36 months, and the 1-year, 2-year, and 5-year DSS rates were 83.7%, 57.4%, and 36.6%, respectively. The median LND was 20%. The 5-year DSS rate was 54.6% for patients with LND 20% v 15.3% for patients with LND higher than 20% (P < .01). Pathologic nodal (pN) status in patients was 78 for pN1 (32%), 127 for pN2 (51%), and 43 for pN3 (17%). On univariate analysis, pN status and LND were significant predictors of DSS (P < .01). However, when pN status and LND were considered jointly in a multivariate model, only LND higher than 20% predicted decreased DSS (hazard ratio [HR], 2.75; P < .01). In addition, while nonorgan-confined (ie, > pT2) primary tumor (HR, 2.40; P < .01) and adjuvant chemotherapy (HR, 0.47; P < .01) were predictors of DSS, LND remained a predictor of DSS even after accounting for adjuvant chemotherapy.

Conclusion LND is superior to TNM nodal status in predicting DSS for patients with lymph node–positive disease after radical cystectomy, even in the context of adjuvant chemotherapy.

Supported by the M.D. Anderson Cancer Center Bladder SPORE (5P50CA091846-03) and a Department of Urology NIH T32 Training Grant CA079449.

W.K. and P.K.A. contributed equally to this work.

Presented at the 2007 Annual American Urological Association meeting, May 22, 2007, Anaheim, CA.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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