Among lymph-node negative bladder cancer patients, survival after radical cystectomy is worse if there is evidence of cancer in lymph or blood vessels, according to a study published in the Journal of Clinical Oncology .
The bladder is a hollow organ in the lower abdomen that stores urine. Bladder cancer is the fifth most common type of cancer in the US. It causes approximately 13,000 deaths annually. Bladder cancer occurs predominantly in elderly men and less frequently in women and younger men. Treatment of bladder cancer may involve surgical removal of the bladder and tissues and organs around it (radical cystectomy).
Many patients who have cancer confined to the bladder at the time of cystectomy subsequently develop a cancer recurrence. The presence of cancer cells in lymph or blood vessels may influence the probability of recurrence. The spread of cancer cells through these vessels is thought to be one of the ways that cancer spreads throughout the body.
In order to assess the relationship between cancer spread to lymph or blood vessels (lymphovascular invasion) and outcomes after cystectomy, researchers in the US evaluated 750 patients with transitional-cell carcinoma who were treated with radical cystectomy between 1984 and 2003. Transitional cell carcinoma refers to bladder cancer involving the cells that line the inside of the bladder. Thirty-six percent of patients had evidence of lymphovascular invasion. Lymphovascular invasion was found in 26% of patients with node-negative cancer and 72% of patients with node-positive cancer. Among patients with node-positive cancer, lymphovascular invasion was not associated with recurrence or survival. Among node-negative patients, however, lymphovascular invasion was associated with an increased risk of cancer recurrence and shorter survival.
The researchers conclude that patients with lymph-node negative bladder cancer have a greater risk of recurrence and shorter survival after cystectomy if they have evidence of cancer cells in lymph or blood vessels. These patients may benefit from chemotherapy as well as surgery.
An accompanying editorial, however, adds this consideration: Since detection of cancer in lymph and blood vessels continues to be challenging, assessment of this type of cancer spread “is not yet a tool for clinical decision making.”
Reference: Lotan Y, Gupta A, Shariat F et al. Lymphovascular invasion is independently associated with overall survival, cause-specific survival, and local and distant recurrence in patients with negative lymph nodes at radical cystectomy. Journal of Clinical Oncology. 2005;23:6533-6539.
Accompanying editorial: Reuter VE. Lymphovascular invasion as an independent predictor of recurrence and survival in node-negative bladder cancer remains to be proven. Journal of Clinical Oncology. 2005;23:6450-6451.
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