Lymph node count at radical cystectomy does not influence long-term survival if surgeons adhere to a standardized template

Elisabeth E Fransen van de Putte; Tom J N Hermans; Erik van Werkhoven; Laura S Mertens; Richard P Meijer; Axel Bex; Annabeth E Wassenaar; Henk G van der Poel; Bas W G van Rhijn; Simon Horenblas

doi:10.1016/j.urolonc.2015.08.001

Lymph node count at radical cystectomy does not influence long-term survival if surgeons adhere to a standardized template

Elisabeth E Fransen van de Putte, Tom J N Hermans, Erik van Werkhoven, Laura S Mertens, Richard P Meijer, Axel Bex, Annabeth E Wassenaar, Henk G van der Poel, Bas W G van Rhijn, Simon Horenblas

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

INTRODUCTION: Multiple bladder cancer studies report that the number of removed lymph nodes (lymph node count [LNC]) at radical cystectomy (RC) is positively associated with survival. Although these reports suggest that LNC can be used as a proxy for surgical quality, all studies used variable or inconsistent pelvic lymph node dissection (PLND) templates. We therefore wished to establish whether LNC at RC influences survival if surgeons adhere to a standardized PLND template.

MATERIALS AND METHODS: We included 274 patients who underwent RC from January 2005 until December 2012. All RCs were performed in either one of 2 hospitals (hospital A or B) by the same 4 urologists (all from hospital A) and a standardized PLND template was applied. PLND specimens were processed by 2 independent pathology departments (hospital A and B). We used Cox regression analysis to investigate the prognostic value of LNC adjusted for patient characteristics. We also compared LNC between hospitals and surgeons and investigated the effect of both the variables on overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS).

RESULTS: Median LNC was 17 (interquartile range = 12). At a median follow-up of 64.3 months, there was no association between LNC and OS (P = 0.328), CSS (P = 0.645), or DFS (P = 0.450). Median LNC was higher in hospital B than in hospital A (20.0 vs. 16.0, P = 0.003). Median LNC varied significantly among surgeons (12-20, P<0.001). Neither the hospital of surgery nor the surgeon performing PLND influenced OS (P = 0.771 and P = 0.982, respectively), CSS (P = 0.310 and P = 0.691, respectively), or DFS (P = 0.256 and P = 0.296, respectively).

CONCLUSION: If surgeons adhere to a standardized template, LNC at RC does not affect long-term survival.

Original language	English
Pages (from-to)	504.e19–504.e24
Journal	Urologic Oncology: Seminars and Original Investigations
Volume	33
Issue number	12
DOIs	https://doi.org/10.1016/j.urolonc.2015.08.001
Publication status	Published - Dec 2015

Keywords

Cystectomy
Female
Humans
Lymph Node Excision
Lymph Nodes
Male
Middle Aged
Survival Analysis
Urinary Bladder Neoplasms

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10.1016/j.urolonc.2015.08.001

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Fransen van de Putte, E. E., Hermans, T. J. N., Werkhoven, E. V., Mertens, L. S., Meijer, R. P., Bex, A., Wassenaar, A. E., van der Poel, H. G., van Rhijn, B. W. G., & Horenblas, S. (2015). Lymph node count at radical cystectomy does not influence long-term survival if surgeons adhere to a standardized template. Urologic Oncology: Seminars and Original Investigations, 33(12), 504.e19–504.e24. https://doi.org/10.1016/j.urolonc.2015.08.001

@article{b81b6355e15a46e988ad7e808eafecec,

title = "Lymph node count at radical cystectomy does not influence long-term survival if surgeons adhere to a standardized template",

abstract = "INTRODUCTION: Multiple bladder cancer studies report that the number of removed lymph nodes (lymph node count [LNC]) at radical cystectomy (RC) is positively associated with survival. Although these reports suggest that LNC can be used as a proxy for surgical quality, all studies used variable or inconsistent pelvic lymph node dissection (PLND) templates. We therefore wished to establish whether LNC at RC influences survival if surgeons adhere to a standardized PLND template.MATERIALS AND METHODS: We included 274 patients who underwent RC from January 2005 until December 2012. All RCs were performed in either one of 2 hospitals (hospital A or B) by the same 4 urologists (all from hospital A) and a standardized PLND template was applied. PLND specimens were processed by 2 independent pathology departments (hospital A and B). We used Cox regression analysis to investigate the prognostic value of LNC adjusted for patient characteristics. We also compared LNC between hospitals and surgeons and investigated the effect of both the variables on overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS).RESULTS: Median LNC was 17 (interquartile range = 12). At a median follow-up of 64.3 months, there was no association between LNC and OS (P = 0.328), CSS (P = 0.645), or DFS (P = 0.450). Median LNC was higher in hospital B than in hospital A (20.0 vs. 16.0, P = 0.003). Median LNC varied significantly among surgeons (12-20, P<0.001). Neither the hospital of surgery nor the surgeon performing PLND influenced OS (P = 0.771 and P = 0.982, respectively), CSS (P = 0.310 and P = 0.691, respectively), or DFS (P = 0.256 and P = 0.296, respectively).CONCLUSION: If surgeons adhere to a standardized template, LNC at RC does not affect long-term survival.",

keywords = "Cystectomy, Female, Humans, Lymph Node Excision, Lymph Nodes, Male, Middle Aged, Survival Analysis, Urinary Bladder Neoplasms",

author = "{Fransen van de Putte}, {Elisabeth E} and Hermans, {Tom J N} and Werkhoven, {Erik van} and Mertens, {Laura S} and Meijer, {Richard P} and Axel Bex and Wassenaar, {Annabeth E} and {van der Poel}, {Henk G} and {van Rhijn}, {Bas W G} and Simon Horenblas",

year = "2015",

month = dec,

doi = "10.1016/j.urolonc.2015.08.001",

language = "English",

volume = "33",

pages = "504.e19–504.e24",

number = "12",

}

Fransen van de Putte, EE, Hermans, TJN, Werkhoven, EV, Mertens, LS, Meijer, RP, Bex, A, Wassenaar, AE, van der Poel, HG, van Rhijn, BWG & Horenblas, S 2015, 'Lymph node count at radical cystectomy does not influence long-term survival if surgeons adhere to a standardized template', Urologic Oncology: Seminars and Original Investigations, vol. 33, no. 12, pp. 504.e19–504.e24. https://doi.org/10.1016/j.urolonc.2015.08.001

Lymph node count at radical cystectomy does not influence long-term survival if surgeons adhere to a standardized template. / Fransen van de Putte, Elisabeth E; Hermans, Tom J N; Werkhoven, Erik van et al.
In: Urologic Oncology: Seminars and Original Investigations, Vol. 33, No. 12, 12.2015, p. 504.e19–504.e24.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Lymph node count at radical cystectomy does not influence long-term survival if surgeons adhere to a standardized template

AU - Fransen van de Putte, Elisabeth E

AU - Hermans, Tom J N

AU - Werkhoven, Erik van

AU - Mertens, Laura S

AU - Meijer, Richard P

AU - Bex, Axel

AU - Wassenaar, Annabeth E

AU - van der Poel, Henk G

AU - van Rhijn, Bas W G

AU - Horenblas, Simon

PY - 2015/12

Y1 - 2015/12

N2 - INTRODUCTION: Multiple bladder cancer studies report that the number of removed lymph nodes (lymph node count [LNC]) at radical cystectomy (RC) is positively associated with survival. Although these reports suggest that LNC can be used as a proxy for surgical quality, all studies used variable or inconsistent pelvic lymph node dissection (PLND) templates. We therefore wished to establish whether LNC at RC influences survival if surgeons adhere to a standardized PLND template.MATERIALS AND METHODS: We included 274 patients who underwent RC from January 2005 until December 2012. All RCs were performed in either one of 2 hospitals (hospital A or B) by the same 4 urologists (all from hospital A) and a standardized PLND template was applied. PLND specimens were processed by 2 independent pathology departments (hospital A and B). We used Cox regression analysis to investigate the prognostic value of LNC adjusted for patient characteristics. We also compared LNC between hospitals and surgeons and investigated the effect of both the variables on overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS).RESULTS: Median LNC was 17 (interquartile range = 12). At a median follow-up of 64.3 months, there was no association between LNC and OS (P = 0.328), CSS (P = 0.645), or DFS (P = 0.450). Median LNC was higher in hospital B than in hospital A (20.0 vs. 16.0, P = 0.003). Median LNC varied significantly among surgeons (12-20, P<0.001). Neither the hospital of surgery nor the surgeon performing PLND influenced OS (P = 0.771 and P = 0.982, respectively), CSS (P = 0.310 and P = 0.691, respectively), or DFS (P = 0.256 and P = 0.296, respectively).CONCLUSION: If surgeons adhere to a standardized template, LNC at RC does not affect long-term survival.

AB - INTRODUCTION: Multiple bladder cancer studies report that the number of removed lymph nodes (lymph node count [LNC]) at radical cystectomy (RC) is positively associated with survival. Although these reports suggest that LNC can be used as a proxy for surgical quality, all studies used variable or inconsistent pelvic lymph node dissection (PLND) templates. We therefore wished to establish whether LNC at RC influences survival if surgeons adhere to a standardized PLND template.MATERIALS AND METHODS: We included 274 patients who underwent RC from January 2005 until December 2012. All RCs were performed in either one of 2 hospitals (hospital A or B) by the same 4 urologists (all from hospital A) and a standardized PLND template was applied. PLND specimens were processed by 2 independent pathology departments (hospital A and B). We used Cox regression analysis to investigate the prognostic value of LNC adjusted for patient characteristics. We also compared LNC between hospitals and surgeons and investigated the effect of both the variables on overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS).RESULTS: Median LNC was 17 (interquartile range = 12). At a median follow-up of 64.3 months, there was no association between LNC and OS (P = 0.328), CSS (P = 0.645), or DFS (P = 0.450). Median LNC was higher in hospital B than in hospital A (20.0 vs. 16.0, P = 0.003). Median LNC varied significantly among surgeons (12-20, P<0.001). Neither the hospital of surgery nor the surgeon performing PLND influenced OS (P = 0.771 and P = 0.982, respectively), CSS (P = 0.310 and P = 0.691, respectively), or DFS (P = 0.256 and P = 0.296, respectively).CONCLUSION: If surgeons adhere to a standardized template, LNC at RC does not affect long-term survival.

KW - Cystectomy

KW - Female

KW - Humans

KW - Lymph Node Excision

KW - Lymph Nodes

KW - Male

KW - Middle Aged

KW - Survival Analysis

KW - Urinary Bladder Neoplasms

U2 - 10.1016/j.urolonc.2015.08.001

DO - 10.1016/j.urolonc.2015.08.001

M3 - Article

C2 - 26329817

SN - 1078-1439

VL - 33

SP - 504.e19–504.e24

JO - Urologic Oncology: Seminars and Original Investigations

JF - Urologic Oncology: Seminars and Original Investigations

IS - 12

ER -

Lymph node count at radical cystectomy does not influence long-term survival if surgeons adhere to a standardized template

Abstract

Keywords

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