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

• Published in: BJU international Vol. 109; no. 8; pp. 1147 - 1154
• Main Authors: Abdollah, Firas, Sun, Maxine, Schmitges, Jan, Djahangirian, Orchidee, Tian, Zhe, Jeldres, Claudio, Perrotte, Paul, Shariat, Shahrokh F., Montorsi, Francesco, Karakiewicz, Pierre I.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.04.2012; Wiley-Blackwell; Wiley Subscription Services, Inc
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Biopsy; Bladder cancer; Carcinoma, Transitional Cell - mortality; Carcinoma, Transitional Cell - secondary; Carcinoma, Transitional Cell - surgery; Cystectomy - methods; Disease-Free Survival; Dissection; Female; Hematologic and hematopoietic diseases; Humans; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; lymph node excision; Lymph Node Excision - methods; Lymph Node Excision - mortality; Lymph Nodes - pathology; Lymph Nodes - surgery; Lymphatic Metastasis; Lymphatic system; Male; Medical sciences; Middle Aged; Mortality; Neoplasm Staging; Nephrology. Urinary tract diseases; Pelvis; Retrospective Studies; SEER Program; survival analysis; Survival Rate - trends; Tumors of the urinary system; United States - epidemiology; urinary bladder neoplasms; Urinary Bladder Neoplasms - mortality; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - surgery; Urinary tract. Prostate gland; United States; Nephrology; neoplasm staging; Staging; Malignant lymphadenopathy; Early stage; SEER program; Urology; Lymphadenectomy; Pelvic ganglion; Urinary bladder; survival analysis; Surgery; urinary bladder neoplasms; Human; Urinary system disease; Program; Excision; Lymph node; Stage classification; Malignant hemopathy; Urinary tract disease; Malignant tumor; Bladder cancer; Survival; Bladder tumor; Lymph node metastasis; Cystectomy; Clinical stage; lymph node excision; Treatment; Urinary system; Bladder disease; lymphatic metastasis; Cancer
• ISSN: 1464-4096; 1464-410X; 1464-410X
• DOI: 10.1111/j.1464-410X.2011.10482.x

Study Type – Therapy (cohort) Level of Evidence 2b What's known on the subject? and What does the study add? In patients treated with radical cystectomy, pelvic lymph node dissection may have a beneficial effect on cancer control outcomes. We examined the effect of pelvic lymph node dissection on stage‐specific cancer control outcomes. OBJECTIVE •  To examine the effect of stage‐specific pelvic lymph node dissection (PLND) on cancer‐specific (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‐confined disease. •  The beneficial 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.