Impact of the Extent of Lymph Node Dissection on Survival Outcomes in Clinically Lymph Node-Positive Bladder Cancer.

von Deimling, Markus; Furrer, Marc; Mertens, Laura S; Mari, Andrea; van Ginkel, Noor; Bacchiani, Mara; Maas, Moritz; Pichler, Renate; Li, Roger; Moschini, Marco; Bianchi, Alberto; Vetterlein, Malte W; Lonati, Chiara; Crocetto, Felice; Taylor, Jacob; Tully, Karl H; Afferi, Luca; Soria, Francesco; Del Giudice, Francesco; Longoni, Mattia; ... (2024). Impact of the Extent of Lymph Node Dissection on Survival Outcomes in Clinically Lymph Node-Positive Bladder Cancer. BJU international, 133(3), pp. 341-350. Wiley 10.1111/bju.16210

Text BJU_International_-_2023_-_von_Deimling_-_Impact_of_the_Extent_of_Lymph_Node_Dissection_on_Survival_Outcomes_in_Clinically.pdf - Accepted Version Restricted to registered users only until 30 October 2024. Available under License Publisher holds Copyright. Download (838kB) | Request a copy

OBJECTIVE

To determine the oncologic impact of extended pelvic lymph node dissection (ePLND) over standard PLND (sPLND) during radical cystectomy (RC) in clinically lymph node-positive (cN+) bladder cancer (BCa).

PATIENTS AND METHODS

In this retrospective, multicenter study we included 969 patients who underwent RC with sPLND (internal/external iliac and obturator lymph nodes) or ePLND (sPLND plus common iliac and presacral nodes) with or without platin-based perioperative chemotherapy for cTany N1-3 M0 BCa between 1991-2022. We assessed the impact of ePLND on recurrence-free survival (RFS) and the distribution of recurrences (locoregional and distant recurrences). The secondary endpoint was overall survival (OS). We performed propensity score matching using covariates associated with the extent of PLND on univariable logistic regression analysis. The association of the extent of PLND with RFS and OS was investigated using Cox regression models.

RESULTS

Of 969 cN+ patients, 510 were 1:1 matched on propensity scores. Median time to recurrence was 8 months (IQR 4-16), and median follow-up of alive patients was 30 months (IQR 13-51). Disease recurrence was observed in 104 patients in the ePLND and 107 in the sPLND group. Of these, 136 patients (27%), 47 patients (9.2%), and 19 patients (3.7%) experienced distant, locoregional, or both distant and locoregional disease recurrence, respectively. When stratified by the extent of PLND, we did not find a difference in recurrence patterns (p>0.05). ePLND improved neither RFS (HR: 0.91; 95%CI 0.70-1.19; p=0.5) nor OS (HR: 0.78; 95%CI: 0.60-1.01; p=0.06) compared to sPLND. Stratification by induction chemotherapy did not change outcomes.

CONCLUSION

Performing an ePLND at the time of RC in cN+ patients improved neither RFS nor OS compared to sPLND, regardless of the induction chemotherapy status. Pretreatment risk stratification is paramount to identify ideal candidates for RC with ePLND as part of a multimodal treatment approach.

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