Impact of the extent of lymph node dissection on survival outcomes in clinically lymph node-positive bladder cancer.
cN+
induction chemotherapy
lymph node-positive
radical cystectomy
template
urinary bladder neoplasms
urothelial cancer
Journal
BJU international
ISSN: 1464-410X
Titre abrégé: BJU Int
Pays: England
ID NLM: 100886721
Informations de publication
Date de publication:
30 Oct 2023
30 Oct 2023
Historique:
pubmed:
31
10
2023
medline:
31
10
2023
entrez:
31
10
2023
Statut:
aheadofprint
Résumé
To determine the oncological impact of extended pelvic lymph node dissection (ePLND) vs standard PLND (sPLND) during radical cystectomy (RC) in clinically lymph node-positive (cN+) bladder cancer (BCa). In this retrospective, multicentre 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 peri-operative chemotherapy for cTany N1-3 M0 BCa between 1991 and 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 in 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. The median (interquartile range [IQR]) time to recurrence was 8 (4-16) months, and median (IQR) follow-up of alive patients was 30 (13-51) months. Disease recurrence was observed in 104 patients in the ePLND and 107 in the sPLND group. Of these, 136 (27%), 47 (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 (hazard ratio [HR] 0.91, 95% confidence interval [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 induction chemotherapy status. Pretreatment risk stratification is paramount to identify ideal candidates for RC with ePLND as part of a multimodal treatment approach.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Investigateurs
Simone Albisinni
(S)
Luca Antonelli
(L)
Ronan Flippot
(R)
Andrea Gallioli
(A)
Abhinav Khanna
(A)
Elisabeth Maier
(E)
Gautier Marcq
(G)
Keiichiro Mori
(K)
Nicolas Penel
(N)
Julien Sarkis
(J)
Maud Velev
(M)
Solomon Woldu
(S)
Informations de copyright
© 2023 The Authors. BJU International published by John Wiley & Sons Ltd on behalf of BJU International.
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