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Speciality Spotlight
Bladder Cancer
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P Lianes, and the National Cancer Institute Bladder Tumor Marker Network [Mem Sloan-Kettering Cancer Ctr, New York; et al]
Biomarker Study of Primary Nonmetastatic Versus Metastatic Invasive Bladder Cancer
Clin Cancer Res 4: 1267-1271, 1998
Conclusion – changes in P53 expression proliferative index, microvascular counts and ploidy status are not strongly correlated with lymph node status in patients with high-stage, high-grade bladder cancer. The association of these markers with the development of systemic metastases and death is apparently independent of disease stage.
Results of this study are surprising in that none of these markers were predictive of lymph node metastases.
This is a little startling in that in several other studies previously reported, each of these markers have individually been shown to a correlate with the development of systemic metastases and death.
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Poulsen AL, Horn T, Steven K [ Univ of Copenhagen ]
Radical cystectomy : Extending the limits of pelvic lymph node dissection improves Survival for patients with bladder cancer confined to the bladder wall
J Urol 160 : 2015-2020, 1998
This article resurrects a simmering controversy on the role of standard radical cystoprostatectomy rather than nerve-sparing cystoprostatectomy controlling muscle invasive bladder cancer. In patients who undergo never sparing radical cystoprostatectomy, some studies have shown that a considerable number of lymph nodes may be left behind in the pelvis and this could contribute to an enhanced risk of local recurrence. This could be especially significant if one believed that adjuvant chemotherapy for patients with demonstrated nodal metastasis was truly benefical.
The authors show that a more radical excision of the pelvic lymph nodes along the pelvic side walls upto aortic bifurcation improves survival. The logical conclusion is that we should not take the “radical” out of radical cystoprostatectomy..
