Role of lymph node dissection in radical cystectomy

Abstract

The number of lymph node dissections (LNDs) is an independent factor influencing the survival time of patients with bladder cancer (BCa) after radical resection (RC). The present study aimed to investigate the association between the number of LNDs and the survival of patients with BCa at different stages and who underwent RC in the United States of America and China. Records from 17,730 American patients with BCa and 158 Chinese patients with BCa were collected from the Surveillance, Epidemiology and End Results (SEER) and the Shanghai Tenth People's Hospital (China) databases, respectively. Kaplan-Meier curve and χ 2 test were used to determine the overall survival time (OS) of patients with BCa. Cox regression analysis was used to analyze the effects of LND number on OS. Overall, 13,421 (75.7%) patients were negative for lymph node metastasis (N0) and 4,309 (24.3%) were positive for lymph node metastasis (N+) among the 17,730 American patients with BCa. In the group of 158 Chinese patients, 125 (79.1%) were N0 and 33 (20.9%) were N+. In the American patients, the median number of dissected nodes was 11.0 [interquartile range (IQR)=3.0-21.0] for N0 patients and 14.0 (IQR=8.0-23.0) for N+ patients. The median number of LNDs was 5.0 (IQR=2.0-7.0) for Chinese N0 patients and 5.0 (IQR=1.5-10.5) for Chinese N+ patients. The number of LNDs may therefore be an independent factor associated with survival in patients who underwent RC. Furthermore, a higher number of LNDs was associated with longer OS in patients with BCa [American patients, ≥13 nodes vs. ≤5 nodes, hazard ratio (HR)=0.62, 95% confidence interval (CI)= 0.59-0.65, P<0.001; Chinese patients, ≥5 nodes vs. ≤1 node, HR=0.27, 95% CI=0.12-0.62, P=0.002]. The number of LNDs in patients with BCa and N+ was higher compared with number of LNDs in patients with BCa and N0 who underwent RC. More extensive LND improved the OS in both the patients from USA and China. Increasing the number of LNDs may therefore be crucial when treating patients with BCa.

Young age increases the risk of lymph node positivity but improves prognosis in patients with bladder cancer treated via cystectomy: a population-based study

“…In general, younger patients tend to be healthier, with favorable immune function and nutritional status as well as a lower risk of comorbidities and fewer treatment-related complications. Previous studies have suggested that younger patients prefer to undergo more complete, radical, and combined treatment modalities than older patients (e.g., LND or extensive LND during RC combined with chemotherapy)-a finding also reflected in our study (13)(14)(15)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29). Indeed, in our study, rates of chemotherapy and the median number of LNE were higher in patients <50 years of age than in patients ≥80 years of age.…”

“…A recent study demonstrated that young patients with MIBC were more likely to have LN metastases than older patients (12). Other studies have also reported a significant association between age and LN status in patients treated with RC (13,14). However, given the limitations of these studies, the precise association between LN+ and patient age at diagnosis of BCa remains to be determined.…”

“…Based on their systematic review, Klaassen et al recommended RC with LND to improve staging and prognosis in patients diagnosed with T1 high-grade BCa (33), given that approximately 5-25% of patients may have occult LN metastases at the time of cystectomy (5,6,34). To date, numerous studies have suggested that extended LND provides a survival benefit in patients undergoing RC (5,13,19). Bi et al conducted a systematic review and meta-analysis, noting that extended LND is associated with improved recurrence-free survival (RFS), in contrast to non-extended LND.…”

Combination of C-Reactive Protein and Neutrophil-to-Lymphocyte Ratio as a Novel Prognostic Index in Patients With Bladder Cancer After Radical Cystectomy

“…According to the TNM stage, BC can be categorized as non-muscular invasive bladder cancer (NMIBC) and muscular invasive bladder cancer (MIBC). Currently, radical cystectomy (RC) with regional pelvic lymphadenectomy (PLND) is the established standard therapy for MIBC and high-risk NMIBC ( 2 , 3 ). However, the survival rate of patients after RC is not satisfactory, with 5-year and 10-year overall survival (OS) rates of 66% and 43%, respectively ( 4 ).…”

Combination of Total Psoas Index and Albumin–Globulin Score for the Prognosis Prediction of Bladder Cancer Patients After Radical Cystectomy: A Population-Based Study

“…Surgery is the most effective treatment for BCa patients, and radical cystectomy (RC), the standard for invasive bladder cancer, has been worldly applied (4). For the accurate prognosis prediction, a series of indicators were introduced to predict the overall survival (OS) and disease-free survival (DFS) of BCa patients after RC, including TNM stage and marital status (5)(6)(7). A simple and effective predictive factor or model for the prognosis of patients assists clinicians to establish the comprehensive individualized treatment of BCa, which will expand the survival time and quality.…”