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Extended Versus Limited Lymph Node Dissection in Bladder Cancer Patients Undergoing Radical Cystectomy: Survival
Jürgen E Gschwend1, Matthias M Heck1, Jan Lehmann2
1Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany.
European Urology
|October 20, 2018
Summary
Extended lymph node dissection (LND) in bladder cancer surgery did not improve recurrence-free survival compared to limited LND. Further research is needed to determine if a small survival benefit exists.
Area of Science:
- Urology
- Surgical Oncology
- Oncology
Background:
- The extent of lymph node dissection (LND) during radical cystectomy for bladder cancer (BCa) may impact oncologic outcomes.
- Limited LND involves the obturator, and internal and external iliac nodes.
- Extended LND includes additional nodes up to the inferior mesenteric artery.
Purpose of the Study:
- To evaluate if extended LND improves recurrence-free survival (RFS) compared to limited LND in urothelial BCa patients.
- To assess the impact of LND extent on cancer-specific survival (CSS) and overall survival (OS).
Main Methods:
- A prospective, multicenter, phase-III trial randomized 401 patients with locally resectable T1G3 or muscle-invasive urothelial BCa (T2-T4aM0).
- Patients were randomized to either limited LND (198 patients) or extended LND (203 patients).
- Primary endpoint was RFS; secondary endpoints included CSS, OS, and complications.
Main Results:
- Extended LND did not demonstrate superiority over limited LND for RFS (5-yr RFS 65% vs 59%), CSS (5-yr CSS 76% vs 65%), or OS (5-yr OS 59% vs 50%).
- The median number of dissected nodes was 31 in the extended arm versus 19 in the limited arm.
- Higher rates of Clavien grade ≥3 lymphoceles were observed within 90 days in the extended LND group.
Conclusions:
- Extended LND failed to show a significant survival advantage over limited LND in bladder cancer patients undergoing radical cystectomy.
- The inclusion of T1G3 tumors might have influenced the negative findings.
- A larger clinical trial is necessary to ascertain any potential small, clinically relevant survival differences.
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