Outcomes of Single Lymph Node Positive Urothelial Carcinoma After Radical Cystectomy

Purpose: We examined clinical outcomes in patients with bladder cancer who underwent radical cystectomy and had 1 positive lymph node compared to none or 2 positive lymph nodes. Materials and Methods: We retrospectively analyzed data on 525 patients who underwent radical cystectomy and pelvic lymphadenectomy for urothelial carcinoma of the bladder and who had none, 1 or 2 positive lymph nodes. The effect of several variables on recurrence-free and disease specific survival was assessed. Results: Of the 525 patients pathological analysis revealed no positive lymph nodes in 448 with organ confined disease (311 or 59.2%) or extravesical disease (137 or 26.1%), 1 positive lymph node in 54 (10.3%) and 2 positive lymph nodes in 23 (4.4%). Five-year recurrence-free and disease specific survival rates were 36.9% and 52.2% in patients with 1 positive lymph node, 51.9% and 56.6% in those with extravesical lymph node negative disease (p = 0.178 and 0.504), and 16.3% and 21.7% in those with 2 positive lymph nodes (p = 0.027 and 0.036, respectively). Multivariate analysis showed that 2 positive lymph nodes were associated with lower recurrence-free and disease specific survival than 1 positive lymph node (HR 2.03, p = 0.021 and HR 2.20, p = 0.015, respectively). However, recurrence-free and disease specific survival rates were not statistically different between patients with extravesical lymph node negative disease and those with 1 positive lymph node (HR 0.70, p = 0.162 and HR 0.72, p = 0.219, respectively) after adjusting for other prognostic variables. Conclusions: Patients with 1 positive lymph node had a prognosis similar to that in lymph node negative patients with extravesical extension. Patients with 1 positive lymph node had a better prognosis than those with 2 positive lymph nodes.