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

Abstract

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. The literature was queried for all articles that directly or indirectly address lymph node density (nodal ratios) and survival of bladder cancer. 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. 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.