Stage‐specific impact of pelvic lymph node dissection on survival in patients with non‐metastatic bladder cancer treated with radical cystectomy

Abstract

4 7What ' s known on the subject? and What does the study add? In patients treated with radical cystectomy, pelvic lymph node dissection may have a benefi cial effect on cancer control outcomes.We examined the effect of pelvic lymph node dissection on stage-specifi c cancer control outcomes. OBJECTIVE• To examine the effect of stage-specifi c pelvic lymph node dissection (PLND) on cancer-specifi c (CSM) and overall mortality (OM) rates at radical cystectomy (RC) for bladder cancer. METHODS• Overall, 11 183 patients were treated with RC within the Surveillance, Epidemiology, and End Results database.• Univariable and multivariable Cox regression analyses tested the effect of PLND on CSM and OM rates, after stratifying according to pathological tumour stage. RESULTS• Overall, PLND was omitted in 25% of patients, and in 50, 35, 27, 16 and 23% of patients with respectively pTa/is, pT1, pT2, pT3 and pT4 disease ( P < 0.001).• For the same stages, the 10-year CSM-free rates for patients undergoing PLND compared with those with no PLND were, respectively, 80 vs 71.9% ( P = 0.02), 81.7 vs 70.0% ( P < 0.001), 71.5 vs 56.1% ( P = 0.001), 43.7 vs 38.8% ( P = 0.006), and 35.1 vs 32.0% ( P = 0.1).• In multivariable analyses, PLND omission was associated with a higher CSM in patients with pTa/is, pT1 and pT2 disease (all P ≤ 0.01), but failed to achieve independent predictor status in patients with pT3 and pT4 disease (both P ≥ 0.05).• Omitting PLND predisposed to a higher OM across all tumour stages (all P ≤ 0.03). CONCLUSIONS• Our results indicate that PLND was more frequently omitted in patients with organ-confi ned disease.• The benefi cial effect of PLND on cancer control outcomes was more evident in these patients than in those with pT3 or pT4 disease.• PLND at RC should always be considered, regardless of tumour stage. KEYWORDSlymphatic metastasis , lymph node excision , neoplasm staging , SEER program , survival analysis , urinary bladder neoplasms Study Type -Therapy (cohort) Level of Evidence 2b

How Far We Should Go with Pelvic Lymph Node Dissection on the Controlateral Side in Unifocal Muscle Invasive Bladder Cancer

“…In terms of overall survival at 18 months with a rate of 71.5% and no local recurrence, this series of patients with unifocal lateral wall MIBC are within the limits described in the literature, and 100% survival at 24 months for patients with T1 and T2 / N0 postoperative also [18]. Cancer specific deads were due to particular histological variants such as micropapillay variant which is asociated with aggresive behavior and poor prognosis [19] The limits of this study are given by the low number of patients enrolled, low follow-up period for survival and recurrence rate, but because we actually watched tumor stage and lymph node status before and after cystectomy this study fulfill the objectives and the good results reported to literature pleades for a standard PLND in these patients with a survival rate in patients with N0 according to previously published studies.…”

Stage‐specific impact of extended versus standard pelvic lymph node dissection in radical cystectomy

“…In fact, the study aimed at evaluating the risk of omitting PLND and, according to guidelines recommendation, 1 the authors concluded suggesting that PLND should be carried out "whenever it can be safely performed". 4 In our series, at univariable analysis, the number of nodes removed (LN-c) was predictive of DFS (log-rank P = 0.003) and CSS (log-rank P = 0.018), but it failed to achieve statistical significance in multivariable analysis; this data would support the importance of defining the anatomical template of PLND, as the median LN-c was 29 and 18 in the e-PLND and s-PLND subgroups, respectively. The optimal LN-c cut-off point, based on which patients were divided into two subgroups, was 27 nodes.…”

“…Regarding the therapeutic role of PLND, many authors showed the negative impact of omitting PLND on oncological outcomes; in a recent paper by Abdollah et al, 4 the authors carried out a retrospective analysis of data collected in the SEER database to address the stage-specific impact of PLND on survival of patients treated with RC. At multivariable Cox analysis, the risk of omitting PLND stratified for pT stage was significant in pTa/is (HR 2.09), in pT1 (HR 1.6), in pT2 (HR 1.68) and pT3 (HR 1.15), but not in pT4 (HR 1.11 [95% CI 0.96-1.28]).…”

“…3 More recently, in a retrospective analysis of data from the SEER database, Abdollah et al showed the increased risk of cancer-specific mortality in patients not receiving PLND during RC, especially in patients with early-stage disease. 4 In 2004, Abol-Enein et al highlighted the minimal risk of nodal metastasis outside the true pelvis in patients without metastasis in pelvic nodes.…”

Differential effect on survival of pelvic lymph node dissection at radical cystectomy for muscle invasive bladder cancer

“…3 However, there is a paucity of data comparing patients treated with radical cystectomy plus PLND vs. radical cystectomy alone, 4,5 and more specifically, data evaluating the potential therapeutic role of PLND according to patients age and comorbidity status are still lacking.…”