Introduction:

Although the prognostic significance of pelvic lymph node metastasis at radical cystectomy is well described, the implications of positive perivesical nodes is less clear. Herein, we investigated the prognostic significance of perivesical nodal metastases detected at cystectomy.

Methods:

We retrospectively reviewed patients who underwent radical cystectomy and packeted pelvic lymph node dissection at our institution between 2000 and 2015, excluding patients with locally advanced disease or who received non-standard preoperative systemic therapies. Nodes identified in the en bloc cystectomy specimen following node dissection were defined as perivesical. We calculated survival outcomes by nodal status and location (perivesical vs other pelvic) and compared hazard ratios for number of positive nodes by location.

Results:

Of the 2,197 patients included, a median of 19 (IQR 12, 28) lymph nodes were removed, with 397 (18%) patients having nodal metastasis. The majority of node-positive patients had only positive pelvic nodes (306, 77%), while 29 (7%) had only positive perivesical nodes and 62 (16%) had both. Among node-positive patients, there was similar recurrence-free or overall survival based on location (log-rank p=0.4, and 0.8, respectively). For every additional positive node, the risk of recurrence (adjusted for consensus T-stage) was also similar regardless of location (HR 1.20 vs 1.09, p >0.2).

Conclusion:

Positive perivesical lymph nodes identified at time of cystectomy carry similar prognostic implications as positive pelvic nodes found during templated packeted lymphadenectomy. Although infrequently found in the absence of positive pelvic nodes, the identification and reporting of perivesical nodes improves staging and can help guide use of adjuvant therapies to improve patient outcomes.

Funding: This research was supported by the Sidney Kimmel Center for Prostate and Urologic Cancers and funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748.