1896 IMPACT OF EXTENDED (E) VERSUS STANDARD LYMPH NODE DISSECTION (SLND) ON POST-CYSTECTOMY SURVIVAL (PCS) AMONG PATIENTS WITH LN-NEGATIVE UROTHELIAL BLADDER CANCER (UBC)

Abstract

You have accessJournal of UrologyBladder Cancer: Staging1 Apr 20111896 IMPACT OF EXTENDED (E) VERSUS STANDARD LYMPH NODE DISSECTION (SLND) ON POST-CYSTECTOMY SURVIVAL (PCS) AMONG PATIENTS WITH LN-NEGATIVE UROTHELIAL BLADDER CANCER (UBC) Ahmed Abd El-Latif, Ranko Miocinovic, Andrew J. Stephenson, Amr Fergany, Adrian Hernandez, and Michael C. Gong Ahmed Abd El-LatifAhmed Abd El-Latif Cleveland, OH More articles by this author , Ranko MiocinovicRanko Miocinovic Cleveland, OH More articles by this author , Andrew J. StephensonAndrew J. Stephenson Cleveland, OH More articles by this author , Amr FerganyAmr Fergany Cleveland, OH More articles by this author , Adrian HernandezAdrian Hernandez Cleveland, OH More articles by this author , and Michael C. GongMichael C. Gong Cleveland, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2020AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Accumulating retrospective data suggests the extent of LND (as determined by the number of LN removed or anatomical templates) is associated with improved PCS. We compared the outcome of patients with pathological LN-negative UBC undergoing eLND vs. sLND during radical cystectomy to assess the impact on an extended template on PCS. METHODS Between years 2006 and 2010, 332 patients underwent open or laparoscopic or robotic RC + LND and had LN-negative disease. Seventeen (5%) patients received neoadjuvant chemotherapy and were included in the final analysis. Patients were divided according to the anatomical LND, where 101 (30%) had level 3 (retroperitoneal LND up to IMA), 98 (29%) had level 2 (up to bifurcation of aorta), 122 (37%) had level 1 (up to common iliac bifurcation), and 11 (4%) had no LND. Comparison of eLND (level 2 + 3) vs. sLND (level 1) for PCS, cancer-specific survival (CSS), and recurrence-free survival (RFS) was analyzed using Cox proportional hazards regression analysis, adjusting for age, American Society of Anesthesia (ASA) score, pT stage, and lymphovascualr invasion (LVI). RESULTS The median follow-up after cystectomy was 24 months (interquartile range [IQR]: 12–36). Patients with level 1, 2, and 3 LND had a median of 14 (IQR, 9–19), 20 (IQR, 16–28), and 35 (IQR, 25–45) nodes removed, respectively (p<0.001). The proportion of patients with pT3–4 cancer receiving perioperative chemotherapy was 23% and 24% in the eLND and sLND groups, respectively (P = 0.8). At 4 years, PCS was 68% (95%CI, 62–74), CSS was 87% (95%CI, 81–93), and RFS was 80% (95%CI, 72–88). In multivariate analyses, eLND was not associated with improved PCS (adjusted HR: 2.5 (0.98–6.5), 95%CI), CSS (adjusted HR: 2 (0.4–11.1), 95%CI), or RFS (adjusted HR: 2.6 (0.7–9.9), 95%CI). Only higher stage (pT3–4) was significantly associated with RFS (adjusted HR: 2.4 (1.3–4.6), 95%CI), CSS (adjusted HR: 3.1 (1.4–6.9), 95%CI), and PCS (adjusted HR: 2.4 (1.5–3.9), 95%CI). CONCLUSIONS While the eLND defines with greater sensitivity the presence of regional LN metastases compared to sPLND, the therapeutic benefit associated with ePLND is uncertain. A significant benefit of ePLND was not observed over short-term follow-up in a large contemporary single-center cohort. Given the uncertainty regarding the therapeutic benefit of ePLND, a randomized trial of ePLND vs. sPLND is needed. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e759 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmed Abd El-Latif Cleveland, OH More articles by this author Ranko Miocinovic Cleveland, OH More articles by this author Andrew J. Stephenson Cleveland, OH More articles by this author Amr Fergany Cleveland, OH More articles by this author Adrian Hernandez Cleveland, OH More articles by this author