Lymph node yield in node-negative patients predicts cancer specific survival following radical cystectomy for transitional cell carcinoma

Abstract

Purpose:To determine the oncological implications of increased nodal dissection in node-negative bladder cancer during radical cystectomy in a contemporary Australian series. Materials and Methods:We performed a multicenter retrospective study, including more than 40 surgeons across 5 sites over a 10-year period. We identified 353 patients with primary bladder cancer undergoing radical cystectomy. Extent of lymphadenectomy was defined as follows; limited pelvic lymph node dissection (PLND) (perivesical, pelvic, and obturator), standard PLND (internal and external iliac) and extended PLND (common iliac). Multivariable cox proportional hazards and logistic regression models were used to determine LNY effect on cancer-specific survival. Results: Over the study period, the extent of dissection and lymph node yield increased considerably. In node-negative patients, lymph node yield (LNY) conferred a significantly improved cancer-specific survival. Compared to cases where LNY of 1 to 5 nodes were taken, the hazard ratio (HR) for 6 to 15 nodes harvested was 0.78 (95% confidence interval [CI], 0.43-1.39) and for greater than 15 nodes the HR was 0.31 (95% CI, 0.17-0.57), adjusted for age, sex, T stage, margin status, and year of surgery. The predicted probability of cancer-specific death within 2 years of cystectomy was 16% (95% CI, 13%-19%) with 10 nodes harvested, falling to 5.5% (95% CI, 0%-12%) with 30 nodes taken. Increasing harvest in all PLND templates conferred a survival benefit. Conclusions:The findings of the current study highlight the improved oncological outcomes with increased LNY, irrespective of the dissection template. Further prospective research is needed to aid LND data interpretation.

Identifying an optimal lymph node yield for penile squamous cell carcinoma: prognostic impact of surgical dissection

“…This also goes in part with known improved outcomes for patients undergoing early upfront ILND rather than waiting for LN disease to develop . In other cancers, an increased LNY has been associated with improved OS, even after a pN0 dissection . The rationale of more extensive LNDs is to remove a greater burden of microscopic metastatic disease; therefore, diminishing the likelihood of recurrence.…”

Evaluating compliance with process‐related quality metrics and survival in oral cavity squamous cell carcinoma: Multi‐institutional oral cavity collaboration study

“…Recent American Society of Clinical Oncology (ASCO) clinical practice guidelines for oral cavity and oropharyngeal squamous cell carcinoma provided a strong recommendation for ipsilateral elective neck dissection in patients with early stage OCSCC 12 . The role for lymph node dissection has been an ongoing topic of research, not just in head and neck cancer but within other areas of surgical oncology, including colorectal, gastric, and urological cancer 13‐16 . Within head and neck cancer research, there is a growing body of literature supporting increased survival outcomes with elective neck dissection in patients with clinically node‐negative disease 17‐20 .…”

“…12 The role for lymph node dissection has been an ongoing topic of research, not just in head and neck cancer but within other areas of surgical oncology, including colorectal, gastric, and urological cancer. [13][14][15][16] Within head and neck cancer research, there is a growing body of literature supporting increased survival outcomes with elective neck dissection in patients with clinically nodenegative disease. [17][18][19][20] In a recently published meta-analysis, de Kort et al reviewed 15 studies looking at lymph node yield as a prognostic factor for survival in head and neck squamous cell carcinoma.…”

A preliminary investigation of precise visualization, localization, and resection of pelvic lymph nodes in bladder cancer by using indocyanine green fluorescence-guided approach through intracutaneous dye injection into the lower limbs and perineum

“…RC combined with PLND can improve patient survival outcomes, even in patients with negative LNs. This is because PLND allows for more accurate LN staging and may remove micrometastases, thereby reducing tumor burden ( 9 , 10 ).…”