Prediction of prognosis after radical cystectomy for pathologic node-negative bladder cancer.

OBJECTIVE: To evaluate risk factors related to bladder cancer recurrence in patients with pathologically negative pelvic lymph nodes.

METHODS: We reviewed 192 patients who underwent radical cystectomy for muscle invasive bladder cancer between 1999 and 2009. Patients with pathologically positive pelvic lymph nodes and <6-month follow-up were excluded. Clinicopathological parameters including grade, stage, lymphadenectomy type (standard vs. extended), number of nodes removed, margin status, lymphovascular invasion, perineural invasion, presence of carcinoma in situ, ureteral invasion, prostatic urethral invasion, and longest tumor dimension were evaluated. Kaplan-Meier and multivariate Cox analyses were used to evaluate these parameters for 5-year recurrence-free survival (5RFS) and 5-year overall survival (5OS).

RESULTS: One hundred and fifty-five patients were included in this study. Mean follow-up duration was 36.6 months (12-141 months). Nuclear grade according to 2004 WHO classification (P = 0.006, P = 0.001), perineural invasion (P = 0.041, P = 0.048), lymphovascular invasion (P = 0.005, P = 0.027), and number of nodes removed (P < 0.001, P < 0.001) demonstrated differences in 5RFS and 5OS, respectively. In multivariate analysis, 5RFS was related to perineural invasion (P = 0.008; HR: 10.951; 95% CI: 1.891-63.407) and the number of nodes removed (P = 0.038; HR: 1.087; 95% CI: 1.004-1.176), and 5OS was correlated with lymphovascular invasion (P = 0.035; HR: 6.694; 95% CI: 1.143-39.217).

CONCLUSIONS: Perineural invasion and the number of nodes removed were independent risk factors for 5RFS, and lymphovascular invasion was for 5OS in patients with node-negative bladder cancer.