From the Research
Urothelial carcinoma with pelvic lymph node involvement is classified as stage IV (specifically N1-3, M0) according to the TNM staging system. This classification is based on the most recent and highest quality study available, which emphasizes the importance of accurate staging in determining prognosis and treatment planning 1. The specific N classification depends on the number and location of involved lymph nodes: N1 indicates a single regional lymph node metastasis in the true pelvis, N2 indicates multiple regional lymph node metastases in the true pelvis, and N3 indicates common iliac lymph node involvement.
Key Considerations
- Pelvic lymph node metastasis indicates that cancer cells have gained access to the lymphatic system, allowing them to spread beyond the bladder or urinary tract.
- The presence of lymphovascular invasion (LVI) on preoperative biopsy is significantly associated with occult pelvic nodal involvement and marginally associated with occult common iliac nodal involvement 2.
- Treatment for stage IV urothelial carcinoma typically involves a multimodal approach including systemic chemotherapy (often cisplatin-based combinations like gemcitabine/cisplatin or dose-dense MVAC), possibly followed by surgical intervention and/or radiation therapy depending on response and patient factors.
Treatment Options
- Systemic chemotherapy with cisplatin-based combinations is a common treatment approach for stage IV urothelial carcinoma.
- Immunotherapy with checkpoint inhibitors may also be considered, especially for patients who are not candidates for cisplatin-based chemotherapy or whose disease has progressed after chemotherapy.
- Surgical intervention, such as radical cystectomy with pelvic lymph node dissection, may be considered in select cases.
Prognosis
- The 5- and 7-year overall survival (OS) rates for patients with cN0 pN+ M0 UCB are 20% and 17%, respectively 1.
- Higher pT stage, higher pN stage, and increasing lymph node density are associated with increased all-cause mortality, while receipt of adjuvant chemotherapy is associated with reduced all-cause mortality.