Which of the following is the most important prognostic factor in muscle-invasive bladder cancer (MIBC) treated with radical cystectomy?

• A Lymphovascular invasion
• B Pathological lymph node status (pN stage) ✓
• C Tumor size (>5 cm vs ≤5 cm)
• D Type of urinary diversion performed

Explanation

Pathological lymph node status is the single most important independent prognostic factor in MIBC after radical cystectomy. Node-positive disease (pN+) is associated with 5-year survival of 25–30% compared to 50–60% for pN0 disease. Lymphovascular invasion is prognostically significant but is a secondary factor. Extended lymph node dissection (to the common iliac vessels and presacral nodes) improves both staging accuracy and survival outcomes. Type of urinary diversion does not affect oncological outcomes.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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