Impact of lymph-node dissection during radical cystectomy for non-muscle-invasive bladder cancer: Japanese multicenter retrospective study

Tomokazu Sazuka ¹, Rikiya Taoka ², Jun Miki ^3,4

¹Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan.
²Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, Japan. taoka.rikiya@kagawa-u.ac.jp.
³Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.
⁴Department of Urology, Jikei University Kashiwa Hospital, Chiba, Japan.
⁵Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
⁶Department of Urology and Andrology, Kansai Medical University, Hirakata, Japan.
⁷Department of Urology, National Cancer Center Hospital, Tokyo, Japan.
⁸Department of Urology, Hirosaki University Graduate School of Medicine, Aomori, Japan.
⁹Department of Urology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
¹⁰Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
¹¹Department of Urology, International University of Health and Welfare Ichikawa Hospital, Ichikawa, Japan.
¹²Department of Urology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.
¹³Department of Urology, Jikei University Hospital, Tokyo, Japan.
¹⁴Department of Urology, Akita University Graduate School of Medicine, Akita, Japan.
¹⁵Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, Japan.
¹⁶Department of Urology, Kurashiki Central Hospital, Okayama, Japan.
¹⁷Department of Urology, Graduate School of Life Science, Kumamoto University, Kumamoto, Japan.
¹⁸Department of Urology, Nara Medical University, Nara, Japan.
¹⁹Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan.
²⁰Department of Urology, Hamamatsu University School of Medicine, Shizuoka, Japan.
²¹Department of Urology, Osaka International Cancer Institute, Osaka, Japan.
²²Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
²³Department of Urology, Graduate School of Medicine, University of the Ryukyus, Ginowan, Japan.
²⁴Department of Nephro-urologic Surgery and Andrology, Mie University Graduate School of Medicine, Mie, Japan.
²⁵Department of Urology, Harasanshin General Hospital, Fukuoka, Japan.
²⁶Department of Urology, Faculty of Medicine, Tottori University, Tottori, Japan.
²⁷Department of Urology, Hyogo Medical University, Hyogo, Japan.
²⁸Department of Urology, Jikei University Katsushika Medical Center, Tokyo, Japan.
²⁹Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan.
³⁰Department of Urology, National Hospital Organization Shikoku Cancer Center, Ehime, Japan.
³¹Department of Urology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
³²Department of Urology, Kurume University School of Medicine, Fukuoka, Japan.
³³Department of Urology, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan.
³⁴Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
³⁵Department of Urology, Faculty of Medicine, Shimane University, Shimane, Japan.
³⁶Department of Urology, Aichi Cancer Center Hospital, Aichi, Japan.
³⁷Department of Nephro-urologic Surgery and Andrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
³⁸Department of Urology, Niigata University Graduate School of Medicine, Niigata, Japan.
³⁹Department of Urology, Faculty of Medicine, University of Toyama, Toyama, Japan.

⁰Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan.

International Journal of Clinical Oncology +

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May 10, 2025

View abstract on PubMed

Summary

Routine lymph-node dissection may not be necessary for all non-muscle-invasive bladder cancer (NMIBC) cases. However, it should be considered for NMIBC involving the bladder neck, as it was identified as a risk factor for recurrence.

Area Of Science

Urology
Oncology
Surgical Oncology

Background

Consensus is lacking on the necessity and impact of lymph-node dissection (LND) during radical cystectomy for non-muscle-invasive bladder cancer (NMIBC).
Evaluating the prognostic significance of LND in NMIBC is crucial for treatment decisions.

Purpose Of The Study

To assess the prognostic value of lymph-node dissection in NMIBC.
To identify preoperative factors associated with non-urinary tract recurrence-free survival (NUTRFS) in NMIBC patients.

Main Methods

Retrospective analysis of 2674 bladder cancer cases from a Japanese multicenter database (2013-2019).
Focus on 410 patients with preoperative NMIBC diagnosis, comparing LND and non-LND groups.
Univariate and multivariate analyses were used to determine NUTRFS prognostic factors.

Main Results

LND was performed in 374/410 patients; 6.9% had pathological lymph node positivity.
LND did not significantly prolong overall survival, even after propensity score matching.
Poor performance status and bladder neck tumors were independent risk factors for NUTRFS.

Conclusions

Routine LND may be unnecessary for all NMIBC cases.
Consider LND for NMIBC involving the bladder neck due to its association with recurrence risk.

Keywords:

Lymph-node dissection Non-muscle-invasive bladder cancer Positivity rate Radical cystectomy Survival