The role of pelvic lymph node metastases in bladder cancer

Among the 153 patients who had undergone cystectomy for primary bladder cancer, the expected deterioration of survival occurred as tumor stage advanced. Of 10 patients with either solitary, small resected intraabdominal metastases or involvement of the urethral margin, none survived longer than 3 years. Another 12 patients were found to have regional lymph node metastases; in 11 of these the positive nodes were located along the iliac or obturator vessels; these individuals also died within 3 years. The 12th patient, who had microscopic metastases in a lymph node from the perivesical fat, was alive with no evidence of disease at 42 months. Among the remaining 131 patients who had no evidence of lymphatic, intraperitoneal or distant metastases, nor tumor at the urethral margin, survival rates were not significantly different for the various pT categories. Our results suggest that patients with deeply invasive bladder carcinoma, but no evidence of extravesical spread (which becomes less likely the deeper the tumor infiltrates) have the same 5-year survival rate as patients with superficially invasive cancer of comparable grade. They also show that lymph node metastases along the pelvic wall portend an unfavorable outcome. However, those who have limited microscopic lymph node metastases, particularly if located in the perivesical fat, may expect a better prognosis as suggested by our patient and the reports in the literature.