Impact of primary tumour characteristics on the survival of patients with lymph node metastases in bladder cancer following radical cystectomy

Background and objective: Patients with carcinoma urinary bladder with metastasis to the lymph nodes have been believed to have a poor prognosis. The various factors affecting survival in this subset of patients are not well understood. To analyze, these factors, we retrospectively analyzed patients who had undergone radical cystectomy at our center in the last 10 years. Methods: From Jan. 1991 to May 2001, 158 patients underwent radical cystectomy at our center. 38 of these were found to have metastasis in the regional lymph nodes (i.e. stage D). A multivariate regression analysis was done to look for factors, which predict a better survival in this group of patients. Patients were studied for age, sex, morphology of tumour (papillary or nodular), grade of tumour, local extent of the disease (T1 T3A OR T3B), lymph nodal involvement, chemotherapy (whether received or not) and no. of TUR resection before radical cystectomy. SPSS software was used and the actuarial disease specific survival calculated for each variable. Results: There were 33 males and 5 females with an age range of 34-75 years (mean 56). Overall survival was 7 months to 84 months with mean of 32 months. Patients with polypoidal disease had better survival (66 months vs 15 months). Also patients with organ-confined disease (T2, T3a) had better survival than those with perivesical spread (T3b). The mean survival in N1 and N2 disease was 36 and 10 months respectively. The benefits of adjuvant chemotherapy (methotrexate and cisplatin) could not be assessed as most of the patients received chemotherapy. Conclusion: Patients with positive lymph nodes for metastases have fairly good survival with radical cystectomy especially those who have a lower T stage (organ confined), papillary morphology and N1 disease.