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Query: UMLS:C0005684 (bladder cancer)
 16,431 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Radical cystectomy and lymphadenectomy is a standard treatment for patients with high-grade, invasive bladder cancer. Although the absolute limits of lymphadectomy at the time of surgery have not been precisely defined, there is a growing body of evidence to suggest that an extended lymph node dissection may be beneficial for staging and survival in both node-negative and -positive bladder cancer patients. For lymph node-positive patients, several prognostic factors have been identified to provide risk stratification and direct the need for adjuvant treatment. These include: the pathological stage of the bladder tumor, extent of the lymphadenectomy and nodal tumor burden. The concept of lymph node density has also been identified as a prognostic factor. The literature and data on the extent of lymphadenectomy will be reviewed as well as the current prognostic variables and the benefits of adjuvant chemotherapy.
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PMID:Risk factors and clinical outcomes of patients with node-positive muscle-invasive bladder cancer. 1858 54

In summary, imaging now has an important role in the evaluation of patients with invasive bladder cancer. It is useful in staging of bladder cancer, despite having some limitations. CT is widely accessible and has enjoyed rapid advances in multidetector technology which have far-reaching applications. MRI, due to its intrinsic tissue characterization, is reported to have a higher accuracy for staging bladder cancer. It is superior to CT in determining the depth of bladder wall invasion. CT, as well as traditional MRI, rely on morphological criteria and are both useful in the detection of metastases to the lymph nodes, liver and bone. MRI, however, can now also take advantage of the tremendous advance in lymph node evaluation brought about by the advent of USPIO nodal imaging. MRI is also considered superior in follow-up of patients with bladder cancer post-therapy as it can distinguish biopsy changes more accurately than CT. In conclusion, it is clear that imaging plays a growing and increasingly important role in the evaluation of patients with bladder cancer.
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PMID:Imaging of urinary tract tumors. 1861 23

Pelvic lymph node metastases from bladder cancer occur in about 25% of patients undergoing radical cystectomy. While the majority of patients with lymph node metastases will develop progressive disease, some patients do exhibit long-term survival with and without adjuvant chemotherapy. The concept of lymph node density has been proposed as a means to stratify patient prognosis since it takes into account two important factors-the number of positive nodes (tumor burden) and the total number of nodes removed/examined (extent of dissection). Due to the lack of agreement on the extent of lymphadenectomy, lymph node density facilitates standardization of lymph node staging, thus allowing for adjuvant therapies and clinical trials to be more uniformly applied. Whether lymph node density provides improved prognostication over the standard nodal staging or absolute number of positive lymph nodes remains controversial. We review the literature regarding the role of lymph node density in the prognostic stratification of node-positive bladder cancer.
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PMID:The role of lymph node density in bladder cancer prognostication. 1902 Aug 82

Little is known about which genes mediate metastasis in bladder cancer, which accounts for much of the mortality of this disease. We used human bladder cancer cell lines to develop models of two clinically common metastatic sites, lung and liver, and evaluated their gene expression with respect to human tumor tissues. Parental cells were injected into either the murine spleen to generate liver metastases or tail vein to generate lung metastases with sequential progeny derived by re-injection and comparisons made of their organ-specific nature by crossed-site injections. Both genomic and transcriptomic analyses of organ-selected cell lines found salient differences and shared core metastatic profiles, which were then screened against gene expression data from human tumors. The expression levels of laminin V gamma 2 (LAMC2) contained in the core metastatic signature were increased as a function of human tumor stage, and its genomic location was in an area of gain as measured by comparative genomic hybridization. Using immunohistochemistry in a human bladder cancer tissue microarray, LAMC2 expression levels were associated with tumor grade, but inversely with nodal status. In contrast, in node-negative patients, LAMC2 expression was associated with visceral metastatic recurrence. In summary, LAMC2 is a novel biomarker of bladder cancer metastasis that reflects the propensity of cells to metastasize via either lymphatic or hematogenous routes.
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PMID:Profiling bladder cancer organ site-specific metastasis identifies LAMC2 as a novel biomarker of hematogenous dissemination. 1914 13

Lymph node status is a key prognostic indicator in patients with bladder cancer, so lymphadenectomy is important for accurate staging. Moreover, lymphadenectomy is curative for some patients with nodal metastases. Although there is evidence that the quality of regional node dissection is associated with oncologic outcome, controversy exists because other factors may also explain this observation. Consequently, there is no consensus regarding the optimal extent of lymphadenectomy and number of nodes that should be assessed.
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PMID:Lymph node assessment and lymphadenectomy in bladder cancer. 1923 78

The surgical management of clinically localized bladder cancer is challenging, and the quality of care delivered to patients with bladder cancer is a subject of increasing interest. Multiple large studies have examined the association between surgical volume and outcomes after radical cystectomy. These studies generally find lower mortality and complication rates at high-volume centers, though interpretation of the data must be tempered by limitations of the datasets driving the studies. Benefits of regionalization of care also must be weighed against other measures proven to predict outcomes; a delay in time to cystectomy beyond 3 months, for example, is strongly associated with increased mortality. Other candidate process measures supported by existing literature include adequacy of lymphadenectomy as measured by nodal yield and availability or offering of orthotopic diversion when appropriate. Assessment and reporting of bladder cancer outcomes should be risk adjusted based on oncologic risk factors and patient comorbid illness. Perioperative morbidity and mortality, cause-specific survival, and overall survival are all key measures. Assessment of health-related quality of life after bladder cancer treatment should also be standardized for reporting. Multiple survey instruments have been developed in recent years, but none has yet been well validated or widely adopted. In particular, capturing variation in quality of life outcomes between patients undergoing bladder-sparing protocols vs. continent diversion vs. incontinent diversion is an important but difficult goal that has not yet been met. The urologic oncology community should take a strong lead in achieving consensus regarding the definition, assessment, and reporting of quality of care data for bladder cancer.
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PMID:Candidate quality of care indicators for localized bladder cancer. 1957 75

Using a novel monoclonal anti-pan human leukocyte antigen (HLA) class I heavy chain antibody (EMR 8-5) reacting with paraffin-embedded sections, we examined the prognostic significance of HLA class I molecules in muscle-invasive bladder cancer patients who underwent radical cystectomy. Immunohistochemical staining for HLA class I molecules with monoclonal antibody EMR 8-5 was performed on specimens from 65 clinically muscle-invasive bladder cancer patients who underwent radical cystectomy and pelvic lymph node dissection without neoadjuvant chemotherapy. We analyzed the clinicopathological and prognostic significance of HLA class I expression. Immunohistochemical analysis revealed HLA class I down-regulation in 22 (33.8%) invasive bladder cancers. This down-regulation had no correlation with clinicopathological parameters such as pathologic stage, nodal status, and grade. The recurrence-free survival of patients with HLA class I-positive tumors was significantly better than that of those with down-regulation (log rank, P = 0.0337). Multivariate analysis revealed that HLA class I expression was a significant factor influencing the recurrence-free survival of bladder cancer patients after cystectomy (P = 0.0155). Our data demonstrate that HLA class I down-regulation in tumor cells was clearly observed in about one-third of the patients. HLA class I expression could be a prognostic marker for muscle-invasive bladder cancer patients after cystectomy.
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PMID:Human leukocyte antigen class I down-regulation in muscle-invasive bladder cancer: its association with clinical characteristics and survival after cystectomy. 1975 Dec 35

Lymph node dissection in bladder cancer is an integral part of radical cystectomy. It allows for accurate staging of the patient and will, therefore, serve to dictate additional treatment and add prognostic information. The issue of what is an adequate lymphadenectomy as to the extent and boundaries of the operation, specifically the cephalad extent, has been the focus of recent debate. Some have suggested that lymph node yield, in terms of number, could serve as a surrogate for the adequacy of the node dissection and, thus, the oncologic efficacy of the operation. It has also been suggested that it is a marker for the experience of the operating surgeon. What is meant by a limited, standard and extended lymph node dissection varies among different publications. Recent evidence suggests that an 'extended' node dissection infers oncologic efficacy. With the advent of minimally invasive and, specifically, robotic-assisted surgery, more cystectomies are approached robotically. As such, there has been recent debate as to whether a robotic-assisted procedure can emulate the open approach, satisfying the accepted boundaries and extent of dissection and ultimately leading to equivalent oncologic outcomes without increasing morbidity. In this review, we focus on the extent of lymphadenectomy in bladder cancer by reviewing the lymphatic drainage and arguments in favor of a more extended dissection. We will then address the minimally invasive techniques, focusing on robotic-assisted surgery, and review the evidence suggesting that this is a promising new technique that results in acceptable nodal yield and potentially equivalent oncologic outcomes with no added morbidity.
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PMID:Lymph node dissection for bladder cancer: the issue of extent and feasibility in the minimally invasive era. 1995 90

To date, radical cystectomy has continued to be the treatment of choice for muscle-invasive bladder cancer. It is associated with a 5-year disease-free survival rate ranging from 27-55%. This outcome is significantly worse when reporting upon locally advanced cases. The independent prognostic factors include: tumor stage, grade, pelvic nodal involvement and some other additional factors. Beside the higher reported incidence of distant metastasis, local recurrence either alone or combined with systemic relapse has been shown to be experienced by 23-50% of locally advanced patients - a rate that was much more frequent than previously believed. Nonrandomized trials of preoperative radiotherapy have suggested improved survival rates. However, only one out of the six randomized preoperative trials in the literature published in English has proved to be significant. On the other hand, the only randomized trial and most retrospective studies dealing with postoperative radiotherapy revealed a significant increase in disease-free survival. Late complications of post operative radiotherapy, contrary to former belief, were acceptable and generally depended upon the volume of the irradiated normal tissues and the radiotherapy techniques used. Most of these adjuvant or neoadjuvant reports were performed in the 1970s and 1980s using conventional radiation techniques. Modern radiotherapy, delivering higher doses to the tumor while saving a significant amount of the surrounding normal structure, has not been rigorously tested. However, these techniques have already succeeded in improving treatment end results in other pelvic tumors.
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PMID:Adjuvant and neoadjuvant radiotherapy for bladder cancer: revisited. 2062 29

Thirty patients with prostate or bladder cancer underwent CT and MRI for nodal staging. CT detected 189 nodes, and MRI detected 271 nodes. This difference was statistically significant in the external iliac (CT/MRI=73/87 nodes), obturator (CT/MRI=48/75 nodes), and internal iliac (CT/MRI=24/46 nodes) nodal chains. Based on size, the number of nodes detected by CT and MRI were as follows: 1-5 mm, CT/MRI=91/166; 6-10 mm, CT/MRI=91/98; >10 mm, CT/MRI=7/7 nodes. MRI detected significantly more lymph nodes in the size range of 1-5 mm.
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PMID:Detection of lymph nodes in pelvic malignancies with Computed Tomography and Magnetic Resonance Imaging. 2081


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