Cancer-specific mortality following radical cystectomy for bladder cancer with lymph node involvement: impact of pathologic disease features and adjuvant chemotherapy.

PURPOSE: While lymph node involvement (LNI) has been associated with adverse outcomes following radical cystectomy (RC), clinicopathologic variables associated with survival continue to be defined. Therefore, we evaluated survival in patients with LNI to define factors associated with death from bladder cancer.
METHODS: We reviewed our institutional registry of 2,462 patients who underwent RC for muscle-invasive urothelial cancer between 1980 and 2006 to identify 307 (12.5 %) patients with LNI. All pathologic specimens were re-reviewed by a single urologic pathologist. Survival was estimated using the Kaplan-Meier method and compared with the log-rank test.
RESULTS: The median number of lymph nodes (LNs) removed among patients with LNI was 12 (IQR 7, 19), and the median number of positive LNs was 2 (IQR 1, 3). Median postoperative follow-up was 8.7 (IQR 5.9, 15.7) years, during which time 255 patients died, including 188 from bladder cancer. On multivariate analysis, advanced tumor stage (HR 1.95; p = 0.046), presence of four or more positive lymph nodes (HR 1.82; p = 0.0022), and the presence of extranodal extension (HR 1.65, p = 0.0012) were associated with a significantly increased risk of death from bladder cancer, while receipt of adjuvant chemotherapy (HR 0.72, p = 0.041) was associated with significantly decreased cancer-specific mortality.
CONCLUSIONS: Advanced pathologic tumor stage and presence of extranodal extension are associated with an increased risk of death from bladder cancer. Receipt of adjuvant chemotherapy is associated with improved survival, supporting the need for prospective clinical trials to assess the role of multimodal therapy in these patients.