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Related Experiment Video

Updated: Jun 6, 2025

Magnetic Resonance Imaging Assessment of Carcinogen-induced Murine Bladder Tumors
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Standard or Extended Lymphadenectomy for Muscle-Invasive Bladder Cancer.

Seth P Lerner1, Catherine Tangen1, Robert S Svatek1

  • 1From Baylor College of Medicine (S.P.L.) and the University of Texas M.D. Anderson Cancer Center (A.M.K.), Houston, the University of Texas Health San Antonio (R.S.S.) and CHRISTUS Santa Rosa Medical Center Hospital (I.M.T.), San Antonio, and the University of Texas Southwestern Medical Center, Dallas (A.I.S.) - all in Texas; Stanford University, Stanford (E.S.), Norris Comprehensive Cancer Center, University of Southern California, Los Angeles (S.D., A.S.), and City of Hope Medical Center, Duarte (S.K.P.) - all in California; SWOG Statistics and Data Management Center and Fred Hutchinson Cancer Center - both in Seattle (C.T., M.P.); the Ohio State University, Columbus (K.S.P.); the University of Chicago, Chicago (N.D.S.); McGill University Health Center, Montreal (W.K.); the Bladder Cancer Advocacy Network, SWOG Advocates, Pittsford, NY (R.B.); Oregon Health and Science University, Portland (T.M.K.); the University of Michigan, Ann Arbor (A.A.); the University of Colorado, Aurora (F.G.L.R.); Brigham and Women's Hospital, Boston (A.S.K.); Fox Chase Cancer Center, Philadelphia (D.J.C.); and Oschsner Medical Center, Jefferson, LA (D.J.C.).

The New England Journal of Medicine
|November 26, 2024
PubMed
Summary

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This summary is machine-generated.

Extended lymphadenectomy did not improve survival for muscle-invasive bladder cancer patients undergoing radical cystectomy. This approach also increased perioperative complications and mortality compared to standard lymphadenectomy.

Area of Science:

  • Urology
  • Surgical Oncology
  • Oncology

Background:

  • The efficacy of extended lymphadenectomy versus standard lymphadenectomy in patients with muscle-invasive bladder cancer undergoing radical cystectomy remains unclear.
  • Determining the optimal lymphadenectomy extent is crucial for improving patient outcomes in bladder cancer treatment.

Purpose of the Study:

  • To compare the disease-free survival and overall survival rates between extended and standard lymphadenectomy in patients with localized muscle-invasive bladder cancer.
  • To assess the safety and perioperative morbidity associated with extended lymphadenectomy.

Main Methods:

  • A randomized controlled trial involving 592 patients with localized muscle-invasive bladder cancer (clinical stage T2-T4a, N0-N2) assigned to either standard or extended lymphadenectomy.

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  • Randomization was stratified by neoadjuvant chemotherapy, tumor stage, and performance status.
  • Primary outcome was disease-free survival; overall survival and safety were also evaluated.
  • Main Results:

    • Extended lymphadenectomy did not significantly improve 5-year disease-free survival (56% vs. 60%) or overall survival (59% vs. 63%) compared to standard lymphadenectomy.
    • The extended lymphadenectomy group experienced higher rates of grade 3-5 adverse events (54% vs. 44%) and 90-day mortality (7% vs. 2%).

    Conclusions:

    • Extended lymphadenectomy is not associated with improved survival outcomes for muscle-invasive bladder cancer patients undergoing radical cystectomy.
    • Extended lymphadenectomy is linked to increased perioperative morbidity and mortality, suggesting standard lymphadenectomy may be preferable.