NMIBC: adequate lymph node dissection improves survival in advanced stages

  • Lenis AT & al.
  • Urol Oncol
  • 20 May 2020

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • The rate of lymph node dissection (LND) has increased over time in patients with nonmuscle invasive bladder cancer (NMIBC) undergoing radical cystectomy.
  • An adequate LND (≥10 lymph nodes examined) is associated with improved OS in advanced stages of disease.

Why this matters

  • The role of LND in nonmuscle invasive disease is unknown.

Study design

  • 3226 patients (mean age, 65.3 years) with urothelial cell carcinoma who underwent radical cystectomy between 2004 and 2013.
  • Funding: None disclosed.

Key results

  • 73.8% of patients had high-grade disease, and 81.0% had cT1 disease.
  • 55% of patients underwent adequate LND.
  • During the study period, the rate of no LND decreased and the rate of adequate LND increased; the rate of inadequate LND remained stable.
  • The mean lymph node yield was 5 for the inadequate cohort and 22 for the adequate LND cohort.
  • In matched patients with vs without adequate LND:
    • Median follow-up was 38.7 months vs 37.5 months.
    • 5-year OS was 68.7% vs 60.6% (P<.01>
  • Adequate LND showed a significant association with OS improvement (HR, 0.75; P<.01>
  • OS improvement was observed for the cT1 stage (OR, 0.75; P<.01 but not the ctis or cta stages.>

Limitations

  • Retrospective.