Computed-tomography based scoring system predicts outcome for clinical lymph node-positive patients undergoing radical cystectomy

PURPOSE: Contrast-enhanced CT scan is the standard staging modality for patients with bladder cancer undergoing radical cystectomy (RC). Involvement of lymph nodes (LN) determines prognosis of patients with bladder cancer. The detection of LN metastasis by CT scan is still insufficient. Therefore, w...

Descripción completa

Detalles Bibliográficos
Autores principales: Eismann, Lennert, Rodler, Severin, Tamalunas, Alexander, Schulz, Gerald, Jokisch, Friedrich, Volz, Yannic, Pfitzinger, Paulo, Schlenker, Boris, Stief, Christian, Solyanik, Olga, Buchner, Alexander, Grimm, Tobias
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Sociedade Brasileira de Urologia 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8691251/
https://www.ncbi.nlm.nih.gov/pubmed/34528776
http://dx.doi.org/10.1590/S1677-5538.IBJU.2021.0329
_version_ 1784618768491610112
author Eismann, Lennert
Rodler, Severin
Tamalunas, Alexander
Schulz, Gerald
Jokisch, Friedrich
Volz, Yannic
Pfitzinger, Paulo
Schlenker, Boris
Stief, Christian
Solyanik, Olga
Buchner, Alexander
Grimm, Tobias
author_facet Eismann, Lennert
Rodler, Severin
Tamalunas, Alexander
Schulz, Gerald
Jokisch, Friedrich
Volz, Yannic
Pfitzinger, Paulo
Schlenker, Boris
Stief, Christian
Solyanik, Olga
Buchner, Alexander
Grimm, Tobias
author_sort Eismann, Lennert
collection PubMed
description PURPOSE: Contrast-enhanced CT scan is the standard staging modality for patients with bladder cancer undergoing radical cystectomy (RC). Involvement of lymph nodes (LN) determines prognosis of patients with bladder cancer. The detection of LN metastasis by CT scan is still insufficient. Therefore, we investigated various CT scan characteristics to predict lymph node ratio (LNR) and its impact on survival. Also, pre-operative CT scan characteristics might hold potential to risk stratify cN+ patients. MATERIALS AND METHODS: We analyzed preoperative CT scans of patients undergoing RC in a tertiary high volume center. Retrospectively, local tumor stage and LN characteristics such as size, morphology (MLN) and number of loco-regional LN (NLN) were investigated and correlation to LNR and survival was analyzed. CT scan characteristics were used to develop a risk stratification using Kaplan-Maier and multivariate analysis. RESULTS: 764 cN0 and 166 cN+ patients with complete follow-up and imaging data were included in the study. Accuracy to detect LN metastasis and locally advanced tumor stage in CT scan was 72% and 62%. LN larger than 15mm in diameter were significantly associated with higher LNR (p=0.002). Increased NLN correlated with decreased CSS and OS (p=0.001: p=0.002). Furthermore, CT scan based scoring system precisely differentiates low-risk and high-risk profiles to predict oncological outcome (p <0.001). CONCLUSION: In our study, solely LN size >15mm significantly correlated with higher LNR. Identification of increased loco-regional LN was associated with worse survival. For the first time, precise risk stratification based on computed-tomography findings was developed to predict oncological outcome for clinical lymph node-positive patients undergoing RC.
format Online
Article
Text
id pubmed-8691251
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Sociedade Brasileira de Urologia
record_format MEDLINE/PubMed
spelling pubmed-86912512021-12-24 Computed-tomography based scoring system predicts outcome for clinical lymph node-positive patients undergoing radical cystectomy Eismann, Lennert Rodler, Severin Tamalunas, Alexander Schulz, Gerald Jokisch, Friedrich Volz, Yannic Pfitzinger, Paulo Schlenker, Boris Stief, Christian Solyanik, Olga Buchner, Alexander Grimm, Tobias Int Braz J Urol Original Article PURPOSE: Contrast-enhanced CT scan is the standard staging modality for patients with bladder cancer undergoing radical cystectomy (RC). Involvement of lymph nodes (LN) determines prognosis of patients with bladder cancer. The detection of LN metastasis by CT scan is still insufficient. Therefore, we investigated various CT scan characteristics to predict lymph node ratio (LNR) and its impact on survival. Also, pre-operative CT scan characteristics might hold potential to risk stratify cN+ patients. MATERIALS AND METHODS: We analyzed preoperative CT scans of patients undergoing RC in a tertiary high volume center. Retrospectively, local tumor stage and LN characteristics such as size, morphology (MLN) and number of loco-regional LN (NLN) were investigated and correlation to LNR and survival was analyzed. CT scan characteristics were used to develop a risk stratification using Kaplan-Maier and multivariate analysis. RESULTS: 764 cN0 and 166 cN+ patients with complete follow-up and imaging data were included in the study. Accuracy to detect LN metastasis and locally advanced tumor stage in CT scan was 72% and 62%. LN larger than 15mm in diameter were significantly associated with higher LNR (p=0.002). Increased NLN correlated with decreased CSS and OS (p=0.001: p=0.002). Furthermore, CT scan based scoring system precisely differentiates low-risk and high-risk profiles to predict oncological outcome (p <0.001). CONCLUSION: In our study, solely LN size >15mm significantly correlated with higher LNR. Identification of increased loco-regional LN was associated with worse survival. For the first time, precise risk stratification based on computed-tomography findings was developed to predict oncological outcome for clinical lymph node-positive patients undergoing RC. Sociedade Brasileira de Urologia 2021-09-10 /pmc/articles/PMC8691251/ /pubmed/34528776 http://dx.doi.org/10.1590/S1677-5538.IBJU.2021.0329 Text en https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Eismann, Lennert
Rodler, Severin
Tamalunas, Alexander
Schulz, Gerald
Jokisch, Friedrich
Volz, Yannic
Pfitzinger, Paulo
Schlenker, Boris
Stief, Christian
Solyanik, Olga
Buchner, Alexander
Grimm, Tobias
Computed-tomography based scoring system predicts outcome for clinical lymph node-positive patients undergoing radical cystectomy
title Computed-tomography based scoring system predicts outcome for clinical lymph node-positive patients undergoing radical cystectomy
title_full Computed-tomography based scoring system predicts outcome for clinical lymph node-positive patients undergoing radical cystectomy
title_fullStr Computed-tomography based scoring system predicts outcome for clinical lymph node-positive patients undergoing radical cystectomy
title_full_unstemmed Computed-tomography based scoring system predicts outcome for clinical lymph node-positive patients undergoing radical cystectomy
title_short Computed-tomography based scoring system predicts outcome for clinical lymph node-positive patients undergoing radical cystectomy
title_sort computed-tomography based scoring system predicts outcome for clinical lymph node-positive patients undergoing radical cystectomy
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8691251/
https://www.ncbi.nlm.nih.gov/pubmed/34528776
http://dx.doi.org/10.1590/S1677-5538.IBJU.2021.0329
work_keys_str_mv AT eismannlennert computedtomographybasedscoringsystempredictsoutcomeforclinicallymphnodepositivepatientsundergoingradicalcystectomy
AT rodlerseverin computedtomographybasedscoringsystempredictsoutcomeforclinicallymphnodepositivepatientsundergoingradicalcystectomy
AT tamalunasalexander computedtomographybasedscoringsystempredictsoutcomeforclinicallymphnodepositivepatientsundergoingradicalcystectomy
AT schulzgerald computedtomographybasedscoringsystempredictsoutcomeforclinicallymphnodepositivepatientsundergoingradicalcystectomy
AT jokischfriedrich computedtomographybasedscoringsystempredictsoutcomeforclinicallymphnodepositivepatientsundergoingradicalcystectomy
AT volzyannic computedtomographybasedscoringsystempredictsoutcomeforclinicallymphnodepositivepatientsundergoingradicalcystectomy
AT pfitzingerpaulo computedtomographybasedscoringsystempredictsoutcomeforclinicallymphnodepositivepatientsundergoingradicalcystectomy
AT schlenkerboris computedtomographybasedscoringsystempredictsoutcomeforclinicallymphnodepositivepatientsundergoingradicalcystectomy
AT stiefchristian computedtomographybasedscoringsystempredictsoutcomeforclinicallymphnodepositivepatientsundergoingradicalcystectomy
AT solyanikolga computedtomographybasedscoringsystempredictsoutcomeforclinicallymphnodepositivepatientsundergoingradicalcystectomy
AT buchneralexander computedtomographybasedscoringsystempredictsoutcomeforclinicallymphnodepositivepatientsundergoingradicalcystectomy
AT grimmtobias computedtomographybasedscoringsystempredictsoutcomeforclinicallymphnodepositivepatientsundergoingradicalcystectomy