Computed-tomography based scoring system predicts outcome for clinical lymph node-positive patients undergoing radical cystectomy
| Autor: | Severin Rodler, Olga Solyanik, Tobias Grimm, Christian G. Stief, Friedrich Jokisch, Lennert Eismann, Yannic Volz, Gerald Schulz, Alexander Tamalunas, Boris Schlenker, Paulo Pfitzinger, Alexander Buchner |
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| Jazyk: | angličtina |
| Rok vydání: | 2022 |
| Předmět: |
medicine.medical_specialty
Scoring system Multivariate analysis medicine.medical_treatment Urology Urinary Bladder Computed tomography Cystectomy Metastasis medicine Humans Lymph node Neoplasm Staging Retrospective Studies Bladder cancer medicine.diagnostic_test business.industry medicine.disease Prognosis Diseases of the genitourinary system. Urology medicine.anatomical_structure Urinary Bladder Neoplasms Lymph Node Excision Original Article Radiology Lymph Lymph Nodes RC870-923 business Tomography X-Ray Computed Editorial Comment Brazil Lymph Node Ratio |
| Zdroj: | International Brazilian Journal of Urology, Vol 48, Iss 1, Pp 89-98 (2022) International braz j urol, Volume: 48, Issue: 1, Pages: 89-98, Published: 12 JAN 2022 International braz j urol v.48 n.1 2022 International Braz J Urol Sociedade Brasileira de Urologia (SBU) instacron:SBU International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology |
| ISSN: | 1677-6119 |
| Popis: | 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 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. |
| Databáze: | OpenAIRE |
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