Does the greater number of lymph nodes removed during standard lymph node dissection predict better patient survival...

To determine whether the number of lymph nodes (LNs) removed during radical cystectomy (RC) and pelvic LN dissection (LND) is associated with patient survival.

Data on 450 patients who underwent RC and standard bilateral pelvic LND for urothelial bladder cancer without receiving neoadjuvant chemotherapy were reviewed. The extent of LND included common iliac artery bifurcation proximally, genitofemoral nerve laterally and the pelvic floor caudally. The impact of the number of LNs removed, analyzed as both continuous and categorical variables, on cancer-specific survival (CSS) and recurrence-free survival (RFS) was analyzed.

The median number of LNs removed was 18 (mean 19.6, range 10-94). Of total 450 patients, 129 (28.7%) had node-positive (N +) disease. For entire patients, the number of LNs removed was not associated with CSS and RFS in the analysis with continuous variable (P = 0.715; P = 0.442, respectively), quartiles (P = 0.924; P = 0.676, respectively), or <18 versus ≥18 LNs removed (5-year CSS rates: 67.0% vs. 69.4%, P = 0.679; 5-year RFS rates = 59.4% vs. 60.6%, P = 0.725, respectively). Similarly, the number of LNs removed was not associated with CSS and RFS in both N0 and N + patients, and in each T stage. Multivariate analyses showed that T stage and lymphovascular invasion were significant predictors for survival in N0 patients, whereas adjuvant chemotherapy and LN density were predictors for survival in N + patients.

If meticulous LND was performed based on standardized LND template during RC, the number of LNs removed was not associated with patient survival.