PD60-11: PROGNOSTIC SIGNIFICANCE OF PERIVESICAL LYMPH NODE STATUS IN PATIENTS WITH MUSCLE-INVASIVE BLADDER CANCER UNDERGOING RADICAL CYSTECTOMY
Friday, May 15, 2020
7:00 AM – 9:00 AM
Nathan C. Wong, Melissa Assel, Cristina Falavolti, Chun Huang, Nima Almassi, Shawn Dason, Victor A. McPherson, Lucas W. Dean, Daniel Sjoberg, Nicole Benfante, Hikmat Al-Ahmadie, Guido Dalbagni, Andrew VIckers, Eugene Cha, Bernard H. Bochner
Introduction: Although the prognostic significance of pelvic lymph node metastasis at radical cystectomy is well described, the implications of positive perivesical nodes are less clear. Herein, we investigated the prognostic significance of perivesical nodal metastases detected at cystectomy.
Methods: We retrospectively reviewed patients who underwent radical cystectomy and packeted pelvic lymph node dissection at our institution between 2000 and 2015, excluding patients with locally advanced disease or who received non-standard preoperative systemic therapies. Nodes identified in the en bloc cystectomy specimen following node dissection were defined as perivesical. We calculated survival outcomes by nodal status and location (perivesical vs other pelvic) and compared hazard ratios for number of positive nodes by location using Cochran’s Q.
Results: Of the 2,197 patients included, a median of 19 (IQR 12, 28) lymph nodes were removed, with 397 (18%) patients having nodal metastasis. The majority of node-positive patients had only positive pelvic nodes (306, 77%), while 29 (7%) had only positive perivesical nodes and 62 (16%) had both. Among node-positive patients, there was similar recurrence-free and overall survival based on location (log-rank p=0.4, and 0.8, respectively). Perivesical and other pelvic positive nodes had a similar prognostic impact with hazard ratio for recurrence (adjusted for consensus T-stage) of 1.20 vs 1.09 respectively per additional positive node (p=0.093 for heterogeneity of hazard ratios).
Conclusions: Positive perivesical lymph nodes identified at time of cystectomy carry similar prognostic implications as positive pelvic nodes found during templated packeted lymphadenectomy. Although infrequently found in the absence of positive pelvic nodes, the identification and reporting of perivesical nodes improves staging and can help guide use of adjuvant therapies to improve patient outcomes. Source of
Funding: This research was supported by the Sidney Kimmel Center for Prostate and Urologic Cancers and funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748.