Extended LND Improves Outcomes in Selected Bladder Cancer Patients

Extended lymph node dissection (LND) does not significantly change overall disease recurrence and survival patterns in patients who undergo radical cystectomy for bladder cancer compared with limited LND, but certain patient subgroups experience improvements in these outcomes, a study found.

Researchers at Aarhus University Hospital in Aarhus, Denmark led by Jørgen Bjerggaard Jensen, MD, compared two different historical cohorts: a group of 265 patients undergoing extended LND and a group undergoing limited LND. Overall, the risk of any recurrence and any lymph node (LN) recurrence within 24 months did not differ significantly between the extended and limited LDN groups (27% vs. 26% and 8% vs. 6%, respectively), according to a report in the International Journal of Urology (published online ahead of print).

Patients with positive lymph nodes had a significantly better prognosis after extended LND. The five-year disease-specific survival was 39% for the extended LND cohort compared with 14% for the limited LND cohort. The five-year recurrence-free survival was 29% and 8%, respectively. Five-year overall survival was 38% and 12%.

Among subjects with non-organ confined tumors, a five-year disease-specific survival and overall survival were significantly better in the extended compared with the limited LND cohort (76% vs.62% and 71% vs. 43%, respectively).

The researchers stated that the overall comparable recurrence patterns observed with extended and limited LND “shows that micrometastasis outside the template of a limited LND are present only in a minority of patients. Otherwise, more substantial differences in recurrence patterns would have been expected.”

They also noted that despite methodological problems in their study, a five-year recurrence-free survival of 29% in LN positive patients in the extended LND cohort shows that some LN positive patients can be cured by surgery alone.