Contemporary rates of adherence to international guidelines for pelvic lymph node dissection in radical cystectomy: a population-based study

Zaffuto, Emanuele; Bandini, Marco; Gazdovich, Stéphanie; Valiquette, Anne-Sophie; Leyh-Bannurah, Sami-Ramzi; Tian, Zhe; Dell’Oglio, Paolo; Graefen, Markus; Moschini, Marco; Necchi, Andrea; Shariat, Shahrokh F.; Briganti, Alberto; Montorsi, Francesco; Karakiewicz, Pierre I.

doi:10.1007/s00345-018-2306-7

Cited by 12 publications

(4 citation statements)

References 18 publications

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“…Perioperative chemotherapy was evenly administered in the different histologic subtypes, with patients with lymphoepitheliomalike UC (25, 65.8%), neuroendocrine tumor (250, 65.4%) and micropapillary UC (91, 51.4%) being most frequently treated with chemotherapy. The median number of removed lymph nodes ranged from 11 to 19 in all the study groups (Figure 2): patients with lymphoepithelioma-like UC had the highest number of lymph nodes removed (median 19, interquartile range [IQR]: 7-26), while patients with giant and spindle cell carcinoma had the lowest (11,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19).…”

Section: Overall Descriptive Characteristicsmentioning

confidence: 99%

“…Lymph node metastases may occur in up to one fourth of patients with muscle-invasive urothelial cancer of the bladder (MIBC) [1], and their presence is an important indicator of long-term survival and cancer recurrence [2][3][4]. Therefore, radical cystectomy with pelvic lymph node dissection (PLND) is the standard treatment for MIBC [5,6].…”

Section: Introductionmentioning

confidence: 99%

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Dissecting patterns of care in patients with variant histology of bladder cancer and lymph node invasion

Bandini¹,

Pederzoli²,

Necchi³

et al. 2021

Société Internationale D’Urologie Journal

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Objectives Lymph node invasion (LNI) is related to long-term survival in patients with muscle-invasive bladder cancer. However, in the case of variant histology (VH), data on pelvic lymph node dissection (PLND) and LNI are sparse. We described the pattern of care of PLND in patients with VHs of bladder cancer, exploring predictors of LNI. Methods Using the 2001–2016 SEER registry, 20 767 bladder cancer patients who underwent PLND were identified. Included histological variants were pure urothelial carcinoma (UC), micropapillary UC, sarcomatoid UC, lymphoepithelioma-like UC, adenocarcinoma, sarcoma, giant and spindle cell carcinoma, squamous cell carcinoma (SCC), and neuroendocrine tumor. Uni- and multivariable logistic regression analyses tested for LNI predictors. Cox regression was used to test for predictors of overall mortality (OM) among both LNI positive and LNI negative patients. Results Overall, 2464 (11.9%) harbored a VH. On multivariate analysis, only micropapillary UC was associated with higher risk (OR = 3.39) of LNI. This association was maintained when only the subset of patients treated without perioperative chemotherapy were analyzed (OR = 3.30). Similarly, higher T stage (T2 stage OR = 2.24; T3–4 stage OR = 9.44) and the use of chemotherapy (OR = 2.29) were associated with a higher risk of LNI. Among patients with LNI (5299, 25.5%), SCC (HR = 1.87), T3–4 stage (HR = 1.94), age at diagnosis (HR = 1.01) and geographic region (south) (HR = 1.22) were predictors of higher risk of OM. Conversely, chemotherapy (HR = 0.69) and number of removed LN (HR = −0.99) were associated with lower risk of OM. Finally, in a subgroup of patients without LNI, sarcomatoid UC (HR = 1.58) and giant and spindle cell carcinoma (HR = 1.83) were the only VH predictors of OM. Conclusions We described different patterns of care in patients with VHs of bladder cancer. Micropapillary UC was an independent risk factor for LNI. Among patients harboring LNI, those with SCC VH had higher OM compared to pure UC. Conversely, sarcomatoid UC and giant and spindle cell carcinoma were predictors of OM in patients without nodal involvement.

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Section: Overall Descriptive Characteristicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dissecting patterns of care in patients with variant histology of bladder cancer and lymph node invasion

Bandini¹,

Pederzoli²,

Necchi³

et al. 2021

Société Internationale D’Urologie Journal

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“…However, adherence to these recommendations is inconsistent and suboptimal, with substantial variability in clinical practices and differences in practice patterns, costs, and outcomes ( 14 - 19 ).…”

Section: Introductionmentioning

confidence: 99%

Quality indicators for the management of muscle-invasive bladder cancer in the perioperative setting of radical cystectomy: a narrative review

König¹,

Pradère²,

Grossmann³

et al. 2022

Transl Cancer Res TCR

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“…The importance of lymphadenectomy (LND) during radical cystectomy has increasingly been recognized in international guidelines [1]. Although further supportive evidence is required, an increasing number of studies have shown that the number of metastatic lymph nodes (LN) and the LN density (positive LN/total LN) are independent predictors of disease evolution [2].…”

Section: Introductionmentioning

confidence: 99%

Is the pN category in radical cystectomy dependent on the pathologist dissection?

Algaba¹

2021

Cancer Rep Rev

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A correlation exists between the number of lymph nodes (LNs) detected in radical cystectomy specimens and the accuracy of pathologic nodal (pN) staging. In this context, correct handling of pathology specimens is crucial, but there is currently no consensus on the optimal methodology. The objective of the present study was to compare two main methods: palpation and complete embedding of all fat tissue. Palpation of LNs and complete embedding of remaining fat tissue were performed in 42 patients. In 33.3% of the patients, no LNs were observed in the remaining fat tissue. The mean number and size of LNs detected were, respectively, 14 and 9 mm with palpation and 2.9 and 5 mm with complete embedding of remaining fat tissue. All positive LNs (30.9%) were detected by palpation. The mean pN density was 12.9% with palpation and 10.7% with complete embedding. All patients with a LN density higher than 20% were already observed by manual palpation.In conclusion, the complete embedding of fat tissue does not have a crucial impact on evaluation of the pN category.

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Contemporary rates of adherence to international guidelines for pelvic lymph node dissection in radical cystectomy: a population-based study

Abstract: It is encouraging to note increasing rates of PLND at RC over time. Both patients and hospital characteristics influence PLND rates. More efforts should be aimed at reducing inequalities in PLND at RC due to these highly modifiable variables.

Cited by 12 publications

References 18 publications

Dissecting patterns of care in patients with variant histology of bladder cancer and lymph node invasion

Dissecting patterns of care in patients with variant histology of bladder cancer and lymph node invasion

Quality indicators for the management of muscle-invasive bladder cancer in the perioperative setting of radical cystectomy: a narrative review

Is the pN category in radical cystectomy dependent on the pathologist dissection?

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