Lymph Node-related Parameters as Prognostic Markers in Lymph Node Positive Bladder Cancer

ABSTRACT

In spite of multidisciplinary treatment, about 70% of lymph node (LN) positive bladder cancer reported to be recurred within 5-year after radical cystectomy and pelvic lymphadenectomy although considerable number of patients survived for a long period without adjuvant treatment after surgery. Current TNM nodal staging system doesn't account for this survival differences. In this regard, several LN-related parameters were developed to predict prognosis of LN positive bladder cancer. In this article, we will state the controversies on current TNM nodal staging system for bladder cancer. In addition, we will review the accuracy of imaging studies to predict LN metastasis before surgery and impact of several surgical and pathologic LN-related parameters, such as extent of lymphadenectomy, number of removed LNs, number of metastatic LNs, LN density, extracapsular extension of LN, on prognosis of LN positive bladder cancer. Moreover, we will review the value of adjuvant chemotherapy on LN positive bladder cancer.