The management of lymph node metastasis from bladder cancer

How reliable are imaging techniques in aging males with bladder cancer?

INTRODUCTION

The aim of this study was to evaluate consistency between clinical lymph node positivity and pathological lymph node positivity in patients undergoing open radical cystectomy and pelvic lymph node dissection due to bladder cancer.

MATERIAL AND METHOD

A total of 135 patients who had open radical cystectomy, extended lymph node dissection, and clear preoperative contrast-enhanced abdominopelvic computed tomography (CT) or magnetic resonance imaging (MRI) images were included in the study. Positive clinical lymph nodes and positive pathological lymph nodeswere recorded. The largest positive clinical and pathological lymph nodeswere recorded. In terms of clinical lymph node involvement, compatibility between radiological findings and pathological results was evaluated.

RESULTS

In the CT group, the sensitivity was 25.81%, specificity was 95.45%, positive predictive value (PPV) was 66.67%, negative predictive value (NPV) was 78.50%, and accuracy was 77.31%. In the MRI group, the sensitivity was 50.00%, specificity was 100%, PPV was 100%, NPV was 76.92%, and accuracy was 81.25%. For consistency between pathological lymph nodes and clinical lymph nodes according to the imaging type, there was no statistically significant difference in the sensitivity, specificity, NPV, and accuracy rates between the imaging techniques (p > 0.05). However, the PPV was significantly higher in the MRI group than the CT group (100% vs.66.67%, respectively; p = 0.014).

CONCLUSION

Positive lymph nodes play a critical role in the prognosis of patients with bladder cancer and the sensitivity of contrast-enhanced abdominopelvic CT and MRI used routinely in clinical practice is low in lymph node detection. MRI seems more reliable than CT in lymph node detection.

Inguinal lymph node metastasis of bladder carcinoma after radical cystectomy: A case report and review of literature

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Chemotherapy with platinum-based regimens remains the mainstay of first-line treatment of metastatic bladder cancer.

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Patients with clinically node-positive bladder tumors have a poor prognosis, with many receiving only chemotherapy.

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Some patients with metastatic bladder cancer can benefit from metastasectomy of lymph nodes.

Introduction

Lymph node metastasis in bladder cancer (BC) is common and has been associated with a very poor prognosis. Bc rarely metastasizes to inguinal lymph nodes.

Presentation of case

We reported an unusual case of right inguinal lymph node metastasis of transitional cell carcinoma of the bladder. Metastasis occurred 9 months after radical cystectomy for BC. The patient refused chemotherapy and underwent only surgical excision of lymph nodes without any adjuvant therapy. During a follow-up period of 3 years, the patient still having complete remission.

Discussion

Multiple studies showed an improved clinical outcome with adjuvant chemotherapy for pathological node-positive patients with BC. Long-term survival could be achieved for some patients with limited lymph node metastasis who underwent metastasectomy. Some studies supported the benefit of surgical consolidation after a good response to systemic chemotherapy. The best management plan for clinically node-positive BC is not established yet.

Conclusion

There is little evidence on which to base the management of inguinal lymph node metastasis from BC. Metastasectomy could be an option with good outcomes.

Expression of PLAGL2 in bladder urothelial carcinoma and its relationship to lymph node metastasis and survival

The purpose of this study was to investigate PLAGL2 expression associated with pathological features and prognosis and predicted lymph node metastases in the bladder urothelial carcinoma (BUC) tissue. The pathologic specimens and clinical data of 203 patients with bladder urothelial carcinoma after radical resection were collected. The expression of PLAGL2 was detected by immunohistochemically staining. The influence on lymph node metastasis and the prognoses of BUC patients were analyzed. The expression of PLAGL2 in BUC and positive lymph nodes was significantly higher than the normal bladder tissues (89.06% and 76.56% vs 21.88%, P < 0.001). Logistic regression analysis showed that PLAGL2 expression was an independent risk factor for BUC lymph node metastasis (P < 0.05). COX proportional hazards regression model showed that the time to recurrence and overall survival of patients with overexpression of PLAGL2 were significantly lower than those with low expression (P < 0.05). PLAGL2 is highly expressed in the BUC tissue and metastatic lymph node relative to the normal bladder tissue. This expression correlates to tumor size and number, and tumor grade and stage. Overexpression of PLAGL2 can be an independent predictor for lymph node metastasis and patient survival.