Relevance of extracapsular extension of pelvic lymph node metastasis in patients with bladder cancer treated in the contemporary era

Abstract

Disease overview: Cutaneous T‐cell lymphomas are a heterogenous group of T‐cell lymphoproliferative disorders involving the skin, the majority of which may be classified as Mycosis fungoides (MF) or Sézary syndrome (SS). Diagnosis: The diagnosis of MF or SS requires the integration of clinical and histopathologic data. Risk‐adapted therapy: Tumor, node, metastasis, and blood (TNMB) staging remains the most important prognostic factor in MF/SS and forms the basis for a “risk‐adapted,” multidisciplinary approach to treatment. For patients with disease limited to the skin, expectant management or skin‐directed therapies is preferred, as both disease‐specific and overall survival for these patients is favorable. In contrast, patients with advanced‐stage disease with significant nodal, visceral, or blood involvement are generally approached with biologic‐response modifiers, denileukin diftitox, and histone deacetylase inhibitors before escalating therapy to include systemic, single‐agent chemotherapy. Multiagent chemotherapy may be used for those patients with extensive visceral involvement requiring rapid disease control. In highly‐selected patients with disease refractory to standard treatments, allogeneic stem‐cell transplantation may be considered. Am. J. Hematol., 2011. © 2011 Wiley‐Liss, Inc.

Lymph node assessment and lymphadenectomy in bladder cancer

“…Higher TNM N category, which is related to both the number of positive nodes and the size of metastases, has been associated with worse outcome in some studies, though not uniformly [33,34]. Additionally, the presence or absence of an intact lymph node capsule has been correlated with prognosis; patients with capsular perforation have diminished survival compared to those without [20,33], although this result has not been corroborated by others [35]. Finally, having a larger proportion of nodes positive for metastatic disease is also associated with diminished prognosis.…”

“…The ratio of the number of positive nodes to the overall number of identified nodes has been termed lymph node density, or lymph node ratio. It has been reported that patients with lymph node densities over 20-25% experience diminished survival [24,31,[35][36][37].…”

Lymphadenektomie im Rahmen der radikalen Zystektomie

“…Eine der bis heute wohl wichtigsten prognostischen Parameter stellt das extrakapsuläre Wachstum dar, welches im Rahmen einer multivariaten Analyse den stärksten prädikti-ven Wert ausmachte [8]. Hingegen konnten Kassouf et al [14] diese Beobachtung im Rahmen ihrer Studie nicht bestäti-gen. Diese Studie basiert aber nur auf den den Autoren vorliegenden Pathologieberichten, eine neuerliche Aufarbeitung der Schnittpräparate erfolgte nicht. Es wird weiter angenommen, dass bei Nachweis von tumorpositiven LK mit extrakapsulä-rem Wachstum ein aggressiverer Tumortyp mit einer höheren Wahrscheinlichkeit und Geschwindigkeit der Metastasierung vorliegt.…”

Lymphadenectomy in Management of Invasive Bladder Cancer

“…Multivariate analyses confirmed that extracapsular extension of LN metastases was the strongest negative predictor for RFS [19]. However, others did not find a significant association between extracapsular extension and survival after RC, leading to issue of whether this pathological finding is really of importance [55]. …”

“…Ghoneim and Abol-Enein introduced the concept of sentinel region (intrapelvic LNs) rather than sentinel node [6, 7]. Involvement of the intrapelvic LNs may be the first step in nodal metastasis in most BCs and skip lesions might be very rare [26, 47, 52, 55–57]. However, higher number of patients and longer followup is needed before widespread practice is accepted.…”