Lymph node dissection during radical cystectomy (RC) may improve oncologic and survival outcomes in patients with clinically diagnosed nonmuscle-invasive bladder cancer (NMIBC), according to investigators.
In a retrospective study of 1647 patients who underwent RC for NMIBC, a lymph node yield greater than 10 (vs 10 or fewer) was significantly associated with a 37% lower risk for local pelvic recurrence-free survival, Stephen A. Boorjian, MD, of Mayo Clinic in Rochester, Minnesota, and colleagues reported in The Journal of Urology. Further, a lymph node yield exceeding 20 was significantly associated with a 33% decreased risk for cancer-specific mortality and a 25% decreased risk for all-cause mortality compared with a lower lymph node yield, the investigators reported. In line with previous reports, male sex was significantly associated with improved oncologic outcomes.
In analyses by clinical T-stage, the cTis and cT1 subgroups showed significant oncologic improvements, but patients with cTa did not.
Based on their findings, the authors proposed that lymph node dissection should be included as part of RC for patients with NMIBC, particularly for patients with cTis or T1 disease.
“To our knowledge, this represents the first analysis to demonstrate an association between the extent of LND and each of these oncologic outcomes specifically in clinical NMIBC patients,” the investigators noted.
In an accompanying editorial, Zachary Hamilton, MD, and Facundo Davaro, MD, of Saint Louis University in St. Louis, Missouri agree.
“Certainly, the oncologic and survival value of [lymph node dissection] is compelling even with suspected NMIBC, and urologists should consider [lymph node dissection] the ‘gold standard’ for radical cystectomy with NMIBC.”
The anatomical extent of lymph node dissection was not standardized and could be more relevant than the lymph node yield, Dr Boorjian and colleagues acknowledged. They recommended that future studies investigate the optimal anatomical template of lymph node dissection at RC for NMIBC.
Due to the retrospective nature of the study, the investigators could not rule out confounders. The study was limited by a lack of information on the indication for RC, bacillus Calmette-Guérin eligibility, and morbidity from lymph node dissection. It’s also possible that some patients with clinical suspicion for muscle-invasive bladder cancer were inadvertently included in the cohort because they had transurethral resection of bladder tumor prior to RC.
Khanna A, Miest T, Sharma V, et al. Role of lymphadenectomy during radical cystectomy for nonmuscle-invasive bladder cancer: Results from a multi-institutional experience. J Urol. doi:10.1097/JU.0000000000002266