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Marcus L Quek Arpeet Shah Eric Kirshenbaum


Pelvic lymph node dissection is a critical component of radical cystectomy for patients with muscle-invasive bladder cancer. Although lymph node involvement is often associated with a poor prognosis, some patients may experience long-term survival when treated with an appropriate lymphadenectomy with and without systemic chemotherapy.  Several lymph node variables have been identified that may provide insight to survivorship of patients with both node-positive and node-negative disease. These variables include lymph node yield, extent of LND, number of positive nodes, location of positive nodes, pathologic stage of the primary tumor, presence of extracapsular nodal extension, size of lymph node metastasis, and lymph node density. These factors may be utilized when counseling patients and directing adjuvant therapy.  Herein, we review the literature regarding several lymph node prognostic variables for patients undergoing radical cystectomy for urothelial bladder cancer

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QUEK, Marcus L; SHAH, Arpeet; KIRSHENBAUM, Eric. PROGNOSTIC INDICATORS OF LYMPH NODE METASTASIS IN. Medical Research Archives, [S.l.], v. 4, n. 7, nov. 2016. ISSN 2375-1924. Available at: <>. Date accessed: 21 july 2018.
lymphadenectomy; lymph node dissection; radical cystectomy; urothelial carcinoma
Review Articles


1. Stein, J.P. et al., 2001. Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. Journal of clinical oncology: official journal of the American Society of Clinical Oncology, 19(3), pp.666–675.

2. Leissner, J. et al., 2000. Lymphadenectomy in patients with transitional cell carcinoma of the urinary bladder; significance for staging and prognosis. BJU international, 85(7), pp.817–823.

3. Poulsen, A.L., Horn, T. & Steven, K., 1998. Radical cystectomy: extending the limits of pelvic lymph node dissection improves survival for patients with bladder cancer confined to the bladder wall. The Journal of urology, 160(6 Pt 1), pp.2015–9; discussion 2020.

4. Steven, K. & Poulsen, A.L., 2007. Radical cystectomy and extended pelvic lymphadenectomy: survival of patients with lymph node metastasis above the bifurcation of the common iliac vessels treated with surgery only. The Journal of urology, 178(4 Pt 1), pp.1218–23; discussion 1223–4.

5. Mandel, P., Tilki, D. & Eslick, G.D., 2014. Extent of lymph node dissection and recurrence-free survival after radical cystectomy: a meta-analysis. Urologic oncology, 32(8), pp.1184–1190.

6. Abdi, H. et al., 2016. Balancing risk and benefit of extended pelvic lymph node dissection in patients undergoing radical cystectomy. World journal of urology, 34(1), pp.41–48.

7. Dorin, R.P. et al., 2011. Lymph node dissection technique is more important than lymph node count in identifying nodal metastases in radical cystectomy patients: a comparative mapping study. European urology, 60(5), pp.946–952.

8. Jensen, J.B., Ulhøi, B.P. & Jensen, K.M.-E., 2010. Lymph node mapping in patients with bladder cancer undergoing radical cystectomy and lymph node dissection to the level of the inferior mesenteric artery. BJU international, 106(2), pp.199–205.

9. Bruins, H.M. et al., 2014. Incidence and location of lymph node metastases in patients undergoing radical cystectomy for clinical non–muscle invasive bladder cancer: Results from a prospective lymph node mapping study. Urologic Oncology: Seminars and Original Investigations, 32(1), pp.24.e13–24.e19.

10. May, M. et al., 2011. Association between the number of dissected lymph nodes during pelvic lymphadenectomy and cancer-specific survival in patients with lymph node-negative urothelial carcinoma of the bladder undergoing radical cystectomy. Annals of surgical oncology, 18(7), pp.2018–2025.

11. Morgan, T.M. et al., 2012. Lymph node yield at radical cystectomy predicts mortality in node-negative and not node-positive patients. Urology, 80(3), pp.632–640.

12. Siemens, D.R. et al., 2015. Lymph node counts are valid indicators of the quality of surgical care in bladder cancer: a population-based study. Urologic oncology, 33(10), pp.425.e15–23.

13. Park, J. et al., 2011. Does the greater number of lymph nodes removed during standard lymph node dissection predict better patient survival following radical cystectomy? World journal of urology, 29(4), pp.443–449.

14. Fleischmann, A. et al., 2005. Prognostic Implications of Extracapsular Extension of Pelvic Lymph Node Metastases in Urothelial Carcinoma of the Bladder. The American journal of surgical pathology, 29(1), pp.89–95.

15. Koppie, T.M. et al., 2006. Standardization of pelvic lymphadenectomy performed at radical cystectomy. Cancer, 107(10), pp.2368–2374.

16. Herr, H.W. et al., 2002. Impact of the number of lymph nodes retrieved on outcome in patients with muscle invasive bladder cancer. The Journal of urology, 167(3), pp.1295–1298.

17. Konety, B.R., Joslyn, S.A. & O’Donnell, M.A., 2003. Extent of Pelvic Lymphadenectomy and Its Impact On Outcome in Patients Diagnosed With Bladder Cancer: Analysis of Data From the Surveillance, Epidemiology and End Results Program Data Base. The Journal of urology, 169(3), pp.946–950.

18. Bochner, B.H., Herr, H.W. & Reuter, V.E., 2001. Impact of separate versus en bloc pelvic lymph node dissection on the number of lymph nodes retrieved in cystectomy specimens. The Journal of urology, 166(6), pp.2295–2296.

19. Fang, A.C. et al., 2010. Effect of a minimum lymph node policy in radical cystectomy and pelvic lymphadenectomy on lymph node yields, lymph node positivity rates, lymph node density, and survivorship in patients with bladder cancer. Cancer, 116(8), pp.1901–1908.

20. Quek et al., 2009. The role of lymph node density in bladder cancer prognostication. World journal of urology, 27(1), pp.27-32.

21. Ku, J.H. et al., 2015. Lymph node density as a prognostic variable in node-positive bladder cancer: a meta-analysis. BMC cancer, 15, p.447.

22. Jeong, I.G. et al., 2011. Comparison of 2002 TNM nodal status with lymph node density in node-positive patients after radical cystectomy for bladder cancer: analysis by the number of lymph nodes removed. Urologic oncology, 29(2), pp.199–204.

23. Osawa, T. et al., 2009. Role of lymph node density in predicting survival of patients with lymph node metastases after radical cystectomy: a multi-institutional study. International journal of urology: official journal of the Japanese Urological Association, 16(3), pp.274–8; discussion 278.

24. Wright, J.L., Lin, D.W. & Porter, M.P., 2008. The association between extent of lymphadenectomy and survival among patients with lymph node metastases undergoing radical cystectomy. Cancer, 112(11), pp.2401–2408.

25. Wiesner, C. et al., 2009. Cancer-specific survival after radical cystectomy and standardized extended lymphadenectomy for node-positive bladder cancer: prediction by lymph node positivity and density. BJU international, 104(3), pp.331–335.

26. Simone, G. et al., 2012. Development and external validation of lymph node density cut-off points in prospective series of radical cystectomy and pelvic lymph node dissection. International journal of urology: official journal of the Japanese Urological Association, 19(12), pp.1068–1074.

27. Kassouf, W. et al., 2013. Critical analysis and validation of lymph node density as prognostic variable in urothelial carcinoma of bladder. Urologic oncology, 31(4), pp.480–486.

28. Karl, A. et al., 2009. The impact of lymphadenectomy and lymph node metastasis on the outcomes of radical cystectomy for bladder cancer. European urology, 55(4), pp.826–835.

29. Ahn, T.S. et al., 2015. Extracapsular Extension of Pelvic Lymph Node Metastasis is an Independent Prognostic Factor in Bladder Cancer: A Systematic Review and Meta-analysis. Annals of surgical oncology, 22(11), pp.3745–3750.

30. Mills, R.D. et al., 2001. Pelvic lymph node metastases from bladder cancer: outcome in 83 patients after radical cystectomy and pelvic lymphadenectomy. The Journal of urology, 166(1), pp.19–23.

31. Stephenson, A.J. et al., 2010. Aggregate lymph node metastasis diameter and survival after radical cystectomy for invasive bladder cancer. Urology, 75(2), pp.382–386.

32. Jensen, J.B., Ulhøi, B.P. & Jensen, K.M.-E., 2012.
Evaluation of different lymph node (LN) variables as prognostic markers in patients undergoing radical cystectomy and extended LN dissection to the level of the inferior mesenteric artery. BJU international, 109(3), pp.388–393.

33. Sørensen, K.P. et al., 2015. Long non-coding RNA expression profiles predict metastasis in lymph node-negative breast cancer independently of traditional prognostic markers. Breast cancer research: BCR, 17, p.55.

34. Prensner, J.R. et al., 2014. RNA biomarkers associated with metastatic progression in prostate cancer: a multi-institutional high-throughput analysis of SChLAP1. The lancet oncology, 15(13), pp.1469–1480.

35. Roepman, P. et al., 2005. An expression profile for diagnosis of lymph node metastases from primary head and neck squamous cell carcinomas. Nature genetics, 37(2), pp.182–186.

36. Laurberg, J.R. et al., 2014. High expression of GEM and EDNRA is associated with metastasis and poor outcome in patients with advanced bladder cancer. BMC cancer, 14, p.638.

37. Smith, S.C. et al., 2011. A 20-gene model for molecular nodal staging of bladder cancer: development and prospective assessment. The lancet oncology, 12(2), pp.137–143.

38. Seiler, R. et al., 2016. Prediction of Lymph Node Metastasis in Patients with Bladder Cancer Using Whole Transcriptome Gene Expression Signatures. The Journal of urology. Available at:

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