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The Clinical Significance Of Micro-Metastatic Lymph Node Disease In Kidney And Bladder Cancer

October 03, 2017

UroToday - Dr. Gschwend (Munich) presented a State-of-the-Art lecture on LN disease in renal and bladder cancers. He began with bladder cancer and that staging correlates with disease specific survival. The stage also correlates with the likelihood of positive LN. Dr. Gschwend stated that surgical LA is the standard for accuracy. MIcrometastasis can be detected in blood, bone marrow and lymph nodes. In bladder cancer, RT-PCR was used to detect LN's that were "negative" by standard pathological staging. Cytokeratin 19 and Uroplakin II have been used as the markers to detect micrometastasis by RT-PCR. In rectal cancer, using this type of technique was an independent prognostic factor for disease-specific survival. This has been shown in bladder cancer, using molecular staging for CK 20 by RT-PCR in bone marrow specimens. In a preliminary German study using RT-PCR for CK 20 in bladder cancer resulted in a 4-fold increase in detection over surgical staging.

Three systems are responsible for development of micrometastasis. They include chemokines, mostly mediated through G-protein coupled receptors. Ligand 12 and CXCR4 on leukocytes is important. But in addition to leukocytes, tumor cells utilize the same mechanism to be directed to LNs. Secondly, lymphangioneogenesis occurs through VEGF pathways. Extracellular matrix metalloproteinase inducer (EMMPRIN) increases invasive enzymes and enhances tumor cell migration and is a third mechanism. EMMPRIN keeps the tumor cells from adhering to one another and facilitates invasion and migration.

In renal cell cancer, the incidence of unsuspected LN positivity is 3.3%. Molecular staging for VHL mutation has not shown a significant yield. However, studies for molecular staging in renal cell cancer to date have been minimal and he encouraged research in this area.

Presented by: J.E. Gschwend, MD, at the European Association of Urology - 23rd Annual EAU Congress - March 26 - 29, 2008 - Milan, Italy

Reported by UroToday Contributing Editor Christopher P. Evans, MD, FACS

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