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).
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.
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.
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.
BJU international. 2023 Oct 30 [Epub ahead of print]
Markus von Deimling, Marc Furrer, Laura S Mertens, Andrea Mari, Noor van Ginkel, Mara Bacchiani, Moritz Maas, Renate Pichler, Roger Li, Marco Moschini, Alberto Bianchi, Malte W Vetterlein, Chiara Lonati, Felice Crocetto, Jacob Taylor, Karl H Tully, Luca Afferi, Francesco Soria, Francesco Del Giudice, Mattia Longoni, Ekaterina Laukhtina, Alessandro Antonelli, Michael Rink, Margit Fisch, Yair Lotan, Philippe E Spiess, Peter C Black, Bernhard Kiss, Benjamin Pradere, Shahrokh F Shariat, CLIPOLY study group collaborators
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Department of Urology, University Hospital of Bern, University of Bern, Bern, Switzerland., Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands., Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy., Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada., Department of Urology, Comprehensive Cancer Center Innsbruck, Medical University of Innsbruck, Innsbruck, Austria., Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA., Department of Urology, Urological Research Institute, Vita-Salute San Raffaele, Milan, Italy., Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy., Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Department of Urology, Spedali Civili of Brescia, Brescia, Italy., Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy., Department of Urology, University of Texas Southwestern, Dallas, Texas, USA., Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany., Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland., Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy., Department of Maternal Infant and Urologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/37904652