Journal Article

Clinical and pathological nodal staging score for urothelial carcinoma of the bladder: an external validation

Haferkamp, A., Bolenz, C., Ellinger, J., Buchner, H., Hohenfellner, M., Riedmiller, H., Trojan, L., Tilki, D., Nuhn, P., Gierth, M., Aziz, A., Burger, M., Otto, W., Tiemann, A., Roigas, J., Fritsche, H. M., Denzinger, S., Bastian, P. J., Zacharias, M., Wieland, W. F., Höfner, T., Müller, S. C., Brookman-May, S., May, M., Stief, C. G., Hermann, E.

2014

Overview

Purpose Radical cystectomy (RC) and pelvic lymph node dissection (LND) are standard treatments for muscle-invasive urothelial carcinoma of the bladder. Lymph node staging is a prerequisite for clinical decision-making regarding adjuvant chemotherapy and follow-up regimens. Recently, the clinical and pathological nodal staging scores (cNSS and pNSS) were developed. Prior to RC, cNSS determines the minimum number of lymph nodes required to be dissected; pNSS quantifies the accuracy of negative nodal staging based on pT stage and dissected LNs. cNSS and pNSS have not been externally validated, and their relevance for prediction of cancer-specific mortality (CSM) has not been assessed. Methods In this retrospective study of 2,483 RC patients from eight German centers, we externally validated cNSS and pNSS and determined their prediction of CSM. All patients underwent RC and LND. Median follow-up was 44 months. cNSS and pNSS sensitivities were evaluated using the original beta-binominal models. Adjusted proportional hazards models were calculated for pN0 patients to assess the predictive value of cNSS and pNSS for CSM. Results cNSS and pNSS both pass external validation. Adjusted for other clinical parameters, cNSS can predict outcome after RC. pNSS has no independent impact on prediction of CSM. The retrospective design is the major limitation of the study. Conclusions In the present external validation, we confirm the validity of both cNSS and pNSS. cNSS is an independent predictor of CSM, thus rendering it useful as a tool for planning the extent of LND.

• Publisher: Springer Berlin Heidelberg,Springer Nature B.V
• Subject: Adult / Aged / Aged, 80 and over / Carcinoma, Transitional Cell - pathology / Carcinoma, Transitional Cell - therapy / Chemotherapy, Adjuvant / Cohort Studies / Cystectomy / Disease-Free Survival / Female / Humans / Lymph Node Excision - methods / Lymph Nodes - pathology / Male / Medicine / Medicine & Public Health / Middle Aged / Neoplasm Staging / Nephrology / Oncology / Original Article / Pelvis / Proportional Hazards Models / Retrospective Studies / Treatment Outcome / Urinary Bladder Neoplasms - pathology / Urinary Bladder Neoplasms - therapy / Urology