The concept of lymph node density--is it ready for clinical practice?

Overview

PURPOSE: The concept of lymph node density (ratio of positive-to-total number of nodes examined) is reviewed as a prognostic factor for recurrence-free survival after cystectomy in patients with invasive bladder cancer. MATERIALS AND METHODS: The literature was queried for all articles that directly or indirectly address lymph node density (nodal ratios) and survival of bladder cancer. RESULTS: Five studies on a total of 979 patients were found. In 4 studies lymph node density was a significant predictive factor for survival when adjusted for patient, tumor and treatment covariates. CONCLUSIONS: Considerable data support the use of lymph node density in bladder cancer prognosis. A methodological evaluation of the prognostic importance of nodal ratios in large multicenter data sets and validation in a prospective clinical trial are merited before lymph node density is accepted into routine clinical practice.