Objective: To identify the prognostic factors influencing survival and to assess the value of extensive lymphadenectomy in invasive bladder cancer with lymph node invasion.
Material and methods: The medical records of 62 patients treated by cystectomy with curative lymphadenectomy for invasive bladder cancer with lymph node invasion were reviewed. Thirty four patients had lymph node dissection ascending at least as far as the common iliac vessels, 26 had pelvic lymph node dissection and 2 had simple lymph node biopsies.
Results: The 2-, 3- and 5-year actuarial survival rates were 37%, 26.6% and 23.6%, respectively, with a median survival of 18.4 months. This study appears to show the independent prognostic value of the following factors: tumour strictly confined to the bladder (< or = pT3a) (p = 0.002), < or = 2 invaded lymph nodes (p = 0.001), N1 lymph node stage (p = 0.009). Extensive lymphadenectomy would not provide any benefit in terms of survival compared to simple pelvic lymph node dissection (p = 0.8). Common iliac node invasion appears to be a factor of poor prognosis when the tumour extends beyond the bladder (> pT3a) (p = 0.018).
Conclusion: In these patients with invasive bladder cancer and lymph node invasion, a number of invaded lymph nodes < or = 2 and local stage < or = pT3a appear to be favourable prognostic factors resulting in a 23.6% remission rate (56.8% when both factors were present simultaneously) after cystectomy plus lymphadenectomy. Extensive lymphadenectomy including the common iliac vessels would not improve survival compared to pelvic lymph node dissection, but nevertheless appears us to be justified, as the presence of common iliac lymph node invasion constitutes a significant and powerful prognostic factor to recommend adjuvant therapy.