WASHINGTON, D.C.—Lymph node density (LN-density) may have prognostic relevance in patients with lymph node-positive bladder cancer (LNposBCA), according to a new German study presented at the American Urological Association 2011 annual meeting.

Patrick J. Bastian, MD, Associate Professor of Urology at the University of Munich, and his colleagues evaluated the prognostic signature of lymphadenectomy variables, including LN-density, in 477 radical cystectomy patients with LN-posBCA. The median follow-up for all living patients was 28 months.

The median number of lymph nodes removed was 12 (range 1-66) and the median number of positive nodes was 2.0 (range 1-25). Among the 477 patients, 290 (60%) presented with stage pN2 disease. The median and mean LN-density was 17.6% and 29%, respectively.  Approximately 56% of the patients exhibited a LN-density of less than 20%; 44% exhibited a LN-density of greater than 20%. After adjusting for age, gender, pTN stage, grade, and associated carcinoma in situ and adjuvant chemotherapy, LN-density greater than 20% was associated with a 65% increased risk of cancer-specific mortality.

“With a cutoff of 20 for lymph density we can probably stratify patients who need additional therapy or who will need only surgical therapy,” Dr. Bastian told Renal & Urology News.  “Some patients may be candidates for a multi-modal treatment approach, rather than just a single approach and that is why it is important that we stratify them. We are the first ones to show that there is a difference in cancer-specific survival.”