[Prognostic value of lymph node dissections in bladder cancer treated with radical cystectomy]. / Valeur pronostique du curage ganglionnaire lors des cystectomies totales pour cancer de la vessie.

ABSTRACT

OBJECTIVE: The objective of this retrospective study was to analyse the impact of lymph node invasion on survival after radical cystectomy for bladder cancer. MATERIAL AND METHODS: From 1988 to 2002, 192 patients underwent radical cystectomy for bladder cancer. Lymph node dissection was performed in 144 patients (75%) with bilateral pelvic lymph node dissection in 130 patients and extension to iliac chains in 14 patients. RESULTS: Lymph node dissection had no impact on medical or surgical morbidity. Lymph node invasion was demonstrated in 35.4% of cases (51/144). Tumour effraction of the lymph node capsule was reported in 70.6% (36/51) of pN+ patients. Lymph node invasion was reported in 16.7% of pT0 patients, 0% of pTa, pTis, pT1 patients and 40, 47 and 48% of pT2, pT3 and pT4 patients, respectively. The mean follow-up was 40.3+/-3.5 months (median 26.6; range 0-207 months). Overall, specific and recurrence-free survivals were significantly influenced by lymph node invasion (p<0.0001, p<0.0001, p<0.0001, respectively) and capsular effraction (p=0.0021, p=0.0027, p=0.0113, respectively). CONCLUSION: Lymph node invasion and especially capsular effraction were significant prognostic factors of overall specific and recurrence-free survival.