Pathologic nodal staging score for bladder cancer: A decision tool for adjuvant therapy after radical cystectomy

Shahrokh F. Shariat; Michael Rink; Behfar Ehdaie; Evanguelos Xylinas; Marek Babjuk; Axel S. Merseburger; Robert S. Svatek; Eugene K. Cha; Scott T. Tagawa; Harun Fajkovic; Giacomo Novara; Pierre I. Karakiewicz; Quoc Dien Trinh; Siamak Daneshmand; Yair Lotan; Wassim Kassouf; Hans Martin Fritsche; Felix K. Chun; Guru Sonpavde; Abdennabi Joual; Douglas S. Scherr; Mithat Gonen

doi:10.1016/j.eururo.2012.06.008

Pathologic nodal staging score for bladder cancer: A decision tool for adjuvant therapy after radical cystectomy

Shahrokh F. Shariat^*, Michael Rink, Behfar Ehdaie, Evanguelos Xylinas, Marek Babjuk, Axel S. Merseburger, Robert S. Svatek, Eugene K. Cha, Scott T. Tagawa, Harun Fajkovic, Giacomo Novara, Pierre I. Karakiewicz, Quoc Dien Trinh, Siamak Daneshmand, Yair Lotan, Wassim Kassouf, Hans Martin Fritsche, Felix K. Chun, Guru Sonpavde, Abdennabi JoualDouglas S. Scherr, Mithat Gonen

^*Corresponding author for this work

Clinic of Urology

49 Citations (Scopus)

Abstract

Background: Radical cystectomy (RC) with pelvic lymph node dissection (PLND) is the standard of care for high-risk non-muscle-invasive and muscle-invasive bladder cancer (BCa). Objective: To develop a model that allows quantification of the likelihood that a pathologically node-negative patient has, indeed, no positive nodes. Design, setting, and participants: We analyzed data from 4335 patients treated with RC and PLND without neoadjuvant chemotherapy at 12 international academic centers. Interventions: Patients underwent RC and PLND. Outcome measurements and statistical analysis: We estimated the sensitivity of pathologic nodal staging using a beta-binomial model and developed a pathologic (postoperative) nodal staging score (pNSS) that represents the probability that a patient is correctly staged as node negative as a function of the number of examined nodes. Results and limitations: Overall, the probability of missing a positive node decreases with the increasing number of nodes examined (52% if 3 nodes are examined, 40% if 5 are examined, and 26% if 10 are examined). The proportion of having a positive node increased proportionally with advancing pathologic T stage and lymphovascular invasion (LVI). Patients with LVI who had 25 examined nodes would have a pNSS of 80% (pT1), 88% (pT2), and 66% (pT3-T4), whereas 10 examined nodes were sufficient for pNSS exceeding 90% in patients without LVI and pT0-T2 tumors. This study is limited because of its retrospective design and multicenter nature. Conclusions: We developed a tool that estimates the likelihood of lymph node (LN) metastasis in BCa patients treated with RC by evaluating the number of examined nodes, the pathologic T stage, and LVI. The pNSS indicates the adequacy of nodal staging in LN-negative patients. This tool could help to refine clinical decision making regarding adjuvant chemotherapy, follow-up scheduling, and inclusion in clinical trials.

Original language	English
Journal	European Urology
Volume	63
Issue number	2
Pages (from-to)	371-378
Number of pages	8
ISSN	0302-2838
DOIs	https://doi.org/10.1016/j.eururo.2012.06.008
Publication status	Published - 02.2013

Funding

Financial disclosures: Shahrokh F. Shariat certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: Dr. Michael Rink is supported by The Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust and a speaker for Pfizer Pharma. S.F. Shariat is an advisory board member of Ferring Pharma. S. Daneshmand is a speaker for Endo Pharmaceuticals.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Research Areas and Centers

Research Area: Luebeck Integrated Oncology Network (LION)

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10.1016/j.eururo.2012.06.008

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Shariat, S. F., Rink, M., Ehdaie, B., Xylinas, E., Babjuk, M., Merseburger, A. S., Svatek, R. S., Cha, E. K., Tagawa, S. T., Fajkovic, H., Novara, G., Karakiewicz, P. I., Trinh, Q. D., Daneshmand, S., Lotan, Y., Kassouf, W., Fritsche, H. M., Chun, F. K., Sonpavde, G., ... Gonen, M. (2013). Pathologic nodal staging score for bladder cancer: A decision tool for adjuvant therapy after radical cystectomy. European Urology, 63(2), 371-378. https://doi.org/10.1016/j.eururo.2012.06.008

@article{6a48684294504c109fdbb0b254e267f5,

title = "Pathologic nodal staging score for bladder cancer: A decision tool for adjuvant therapy after radical cystectomy",

abstract = "Background: Radical cystectomy (RC) with pelvic lymph node dissection (PLND) is the standard of care for high-risk non-muscle-invasive and muscle-invasive bladder cancer (BCa). Objective: To develop a model that allows quantification of the likelihood that a pathologically node-negative patient has, indeed, no positive nodes. Design, setting, and participants: We analyzed data from 4335 patients treated with RC and PLND without neoadjuvant chemotherapy at 12 international academic centers. Interventions: Patients underwent RC and PLND. Outcome measurements and statistical analysis: We estimated the sensitivity of pathologic nodal staging using a beta-binomial model and developed a pathologic (postoperative) nodal staging score (pNSS) that represents the probability that a patient is correctly staged as node negative as a function of the number of examined nodes. Results and limitations: Overall, the probability of missing a positive node decreases with the increasing number of nodes examined (52\% if 3 nodes are examined, 40\% if 5 are examined, and 26\% if 10 are examined). The proportion of having a positive node increased proportionally with advancing pathologic T stage and lymphovascular invasion (LVI). Patients with LVI who had 25 examined nodes would have a pNSS of 80\% (pT1), 88\% (pT2), and 66\% (pT3-T4), whereas 10 examined nodes were sufficient for pNSS exceeding 90\% in patients without LVI and pT0-T2 tumors. This study is limited because of its retrospective design and multicenter nature. Conclusions: We developed a tool that estimates the likelihood of lymph node (LN) metastasis in BCa patients treated with RC by evaluating the number of examined nodes, the pathologic T stage, and LVI. The pNSS indicates the adequacy of nodal staging in LN-negative patients. This tool could help to refine clinical decision making regarding adjuvant chemotherapy, follow-up scheduling, and inclusion in clinical trials.",

author = "Shariat, \{Shahrokh F.\} and Michael Rink and Behfar Ehdaie and Evanguelos Xylinas and Marek Babjuk and Merseburger, \{Axel S.\} and Svatek, \{Robert S.\} and Cha, \{Eugene K.\} and Tagawa, \{Scott T.\} and Harun Fajkovic and Giacomo Novara and Karakiewicz, \{Pierre I.\} and Trinh, \{Quoc Dien\} and Siamak Daneshmand and Yair Lotan and Wassim Kassouf and Fritsche, \{Hans Martin\} and Chun, \{Felix K.\} and Guru Sonpavde and Abdennabi Joual and Scherr, \{Douglas S.\} and Mithat Gonen",

note = "Funding Information: Financial disclosures: Shahrokh F. Shariat certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: Dr. Michael Rink is supported by The Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust and a speaker for Pfizer Pharma. S.F. Shariat is an advisory board member of Ferring Pharma. S. Daneshmand is a speaker for Endo Pharmaceuticals. Copyright: Copyright 2013 Elsevier B.V., All rights reserved.",

year = "2013",

month = feb,

doi = "10.1016/j.eururo.2012.06.008",

language = "English",

volume = "63",

pages = "371--378",

journal = "European Urology",

issn = "0302-2838",

publisher = "Elsevier B.V.",

number = "2",

}

Shariat, SF, Rink, M, Ehdaie, B, Xylinas, E, Babjuk, M, Merseburger, AS, Svatek, RS, Cha, EK, Tagawa, ST, Fajkovic, H, Novara, G, Karakiewicz, PI, Trinh, QD, Daneshmand, S, Lotan, Y, Kassouf, W, Fritsche, HM, Chun, FK, Sonpavde, G, Joual, A, Scherr, DS & Gonen, M 2013, 'Pathologic nodal staging score for bladder cancer: A decision tool for adjuvant therapy after radical cystectomy', European Urology, vol. 63, no. 2, pp. 371-378. https://doi.org/10.1016/j.eururo.2012.06.008

TY - JOUR

T1 - Pathologic nodal staging score for bladder cancer: A decision tool for adjuvant therapy after radical cystectomy

AU - Shariat, Shahrokh F.

AU - Rink, Michael

AU - Ehdaie, Behfar

AU - Xylinas, Evanguelos

AU - Babjuk, Marek

AU - Merseburger, Axel S.

AU - Svatek, Robert S.

AU - Cha, Eugene K.

AU - Tagawa, Scott T.

AU - Fajkovic, Harun

AU - Novara, Giacomo

AU - Karakiewicz, Pierre I.

AU - Trinh, Quoc Dien

AU - Daneshmand, Siamak

AU - Lotan, Yair

AU - Kassouf, Wassim

AU - Fritsche, Hans Martin

AU - Chun, Felix K.

AU - Sonpavde, Guru

AU - Joual, Abdennabi

AU - Scherr, Douglas S.

AU - Gonen, Mithat

N1 - Funding Information: Financial disclosures: Shahrokh F. Shariat certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: Dr. Michael Rink is supported by The Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust and a speaker for Pfizer Pharma. S.F. Shariat is an advisory board member of Ferring Pharma. S. Daneshmand is a speaker for Endo Pharmaceuticals. Copyright: Copyright 2013 Elsevier B.V., All rights reserved.

PY - 2013/2

Y1 - 2013/2

N2 - Background: Radical cystectomy (RC) with pelvic lymph node dissection (PLND) is the standard of care for high-risk non-muscle-invasive and muscle-invasive bladder cancer (BCa). Objective: To develop a model that allows quantification of the likelihood that a pathologically node-negative patient has, indeed, no positive nodes. Design, setting, and participants: We analyzed data from 4335 patients treated with RC and PLND without neoadjuvant chemotherapy at 12 international academic centers. Interventions: Patients underwent RC and PLND. Outcome measurements and statistical analysis: We estimated the sensitivity of pathologic nodal staging using a beta-binomial model and developed a pathologic (postoperative) nodal staging score (pNSS) that represents the probability that a patient is correctly staged as node negative as a function of the number of examined nodes. Results and limitations: Overall, the probability of missing a positive node decreases with the increasing number of nodes examined (52% if 3 nodes are examined, 40% if 5 are examined, and 26% if 10 are examined). The proportion of having a positive node increased proportionally with advancing pathologic T stage and lymphovascular invasion (LVI). Patients with LVI who had 25 examined nodes would have a pNSS of 80% (pT1), 88% (pT2), and 66% (pT3-T4), whereas 10 examined nodes were sufficient for pNSS exceeding 90% in patients without LVI and pT0-T2 tumors. This study is limited because of its retrospective design and multicenter nature. Conclusions: We developed a tool that estimates the likelihood of lymph node (LN) metastasis in BCa patients treated with RC by evaluating the number of examined nodes, the pathologic T stage, and LVI. The pNSS indicates the adequacy of nodal staging in LN-negative patients. This tool could help to refine clinical decision making regarding adjuvant chemotherapy, follow-up scheduling, and inclusion in clinical trials.

AB - Background: Radical cystectomy (RC) with pelvic lymph node dissection (PLND) is the standard of care for high-risk non-muscle-invasive and muscle-invasive bladder cancer (BCa). Objective: To develop a model that allows quantification of the likelihood that a pathologically node-negative patient has, indeed, no positive nodes. Design, setting, and participants: We analyzed data from 4335 patients treated with RC and PLND without neoadjuvant chemotherapy at 12 international academic centers. Interventions: Patients underwent RC and PLND. Outcome measurements and statistical analysis: We estimated the sensitivity of pathologic nodal staging using a beta-binomial model and developed a pathologic (postoperative) nodal staging score (pNSS) that represents the probability that a patient is correctly staged as node negative as a function of the number of examined nodes. Results and limitations: Overall, the probability of missing a positive node decreases with the increasing number of nodes examined (52% if 3 nodes are examined, 40% if 5 are examined, and 26% if 10 are examined). The proportion of having a positive node increased proportionally with advancing pathologic T stage and lymphovascular invasion (LVI). Patients with LVI who had 25 examined nodes would have a pNSS of 80% (pT1), 88% (pT2), and 66% (pT3-T4), whereas 10 examined nodes were sufficient for pNSS exceeding 90% in patients without LVI and pT0-T2 tumors. This study is limited because of its retrospective design and multicenter nature. Conclusions: We developed a tool that estimates the likelihood of lymph node (LN) metastasis in BCa patients treated with RC by evaluating the number of examined nodes, the pathologic T stage, and LVI. The pNSS indicates the adequacy of nodal staging in LN-negative patients. This tool could help to refine clinical decision making regarding adjuvant chemotherapy, follow-up scheduling, and inclusion in clinical trials.

UR - https://www.scopus.com/pages/publications/84871920557

U2 - 10.1016/j.eururo.2012.06.008

DO - 10.1016/j.eururo.2012.06.008

M3 - Journal articles

C2 - 22727174

AN - SCOPUS:84871920557

SN - 0302-2838

VL - 63

SP - 371

EP - 378

JO - European Urology

JF - European Urology

IS - 2

ER -

Pathologic nodal staging score for bladder cancer: A decision tool for adjuvant therapy after radical cystectomy

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