Impact of Extended Lymph Node Dissection on Survival Outcomes in Patients With Bladder Cancer and Upper Tract Urothelial Carcinoma: A Multicenter Retrospective Study

Purpose: To evaluate whether extended pelvic lymph node dissection (PLND) improves survival outcomes compared with standard PLND in patients with bladder cancer (BCa) undergoing radical cystectomy (RC), and to assess its potential benefits in patients with prior or concurrent radical nephroureterectomy (p/cRNU).Materials and Methods: A multicenter analysis included 2202 patients with BCa undergoing RC with standard or extended PLND at 11 tertiary centers from 2003 to 2023. Following propensity score matching, 659 pairs (n=1,318), including 128 patients with p/cRNU, were analyzed. Recurrence-free survival (RFS) was the primary outcome, while overall survival (OS), cancer-specific survival (CSS), and readmission rates were secondary outcomes. Survival analyses performed using Kaplan-Meier methods and clustered Cox models.Results: Extended PLND yielded significantly more lymph nodes than standard PLND (median: 27.0 vs. 17.0, p<0.001) but did not improve RFS, CSS, or OS in the overall cohort (all p>0.05). Extended PLND increased readmission rates (28.4% vs. 20.2%, p=0.001) and readmission risk (odds ratio, 1.57; 95% confidence interval [CI], 1.15–2.16, p=0.005). However, subgroup analysis revealed extended PLND significantly improved RFS in patients with p/cRNU (hazard ratio, 0.54; 95% CI, 0.38–0.77; p<0.001).Conclusion: Extended PLND does not provide survival benefits for overall patient population and increases readmission risk but significantly improves RFS in patients with p/cRNU. Tailoring PLND extent based on upper tract disease status is recommended.

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Journal
Journal of Urologic Oncology
Published
2025-03-27
DOI
https://doi.org/10.22465/juo.255000320016
Citations
1
Primary Topic
Bladder and Urothelial Cancer Treatments
Type
article
Field-Weighted Citation Impact
2.01

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article

Impact of Extended Lymph Node Dissection on Survival Outcomes in Patients With Bladder Cancer and Upper Tract Urothelial Carcinoma: A Multicenter Retrospective Study

Bumjin Lim, Wan Song, Jiwoong Yu, Ji Eun Heo et al.
1 citations
Journal of Urologic Oncology
Bladder and Urothelial Cancer Treatments
2.01
article

Impact of Extended Lymph Node Dissection on Survival Outcomes in Patients With Bladder Cancer and Upper Tract Urothelial Carcinoma: A Multicenter Retrospective Study

Bumjin Lim, Wan Song, Jiwoong Yu, Ji Eun Heo, Ja Hyeon Ku, Byong Chang Jeong, Joongwon Choi, Geehyun Song, Kyung Hwan Kim, Tae Il Noh, Yun‐Sok Ha, Seung‐hwan Jeong, Hwang Gyun Jeon, Seong Soo Jeon, Jong Jin Oh, Ho Kyung Seo, Seong Il Seo, Jong Kil Nam, Seok Ho Kang, Bumsik Hong, Won Sik Ham, Minyong Kang, Wook Nam, Hyun Hwan Sung
article en
1 citations

Abstract

Purpose: To evaluate whether extended pelvic lymph node dissection (PLND) improves survival outcomes compared with standard PLND in patients with bladder cancer (BCa) undergoing radical cystectomy (RC), and to assess its potential benefits in patients with prior or concurrent radical nephroureterectomy (p/cRNU).Materials and Methods: A multicenter analysis included 2202 patients with BCa undergoing RC with standard or extended PLND at 11 tertiary centers from 2003 to 2023. Following propensity score matching, 659 pairs (n=1,318), including 128 patients with p/cRNU, were analyzed. Recurrence-free survival (RFS) was the primary outcome, while overall survival (OS), cancer-specific survival (CSS), and readmission rates were secondary outcomes. Survival analyses performed using Kaplan-Meier methods and clustered Cox models.Results: Extended PLND yielded significantly more lymph nodes than standard PLND (median: 27.0 vs. 17.0, p<0.001) but did not improve RFS, CSS, or OS in the overall cohort (all p>0.05). Extended PLND increased readmission rates (28.4% vs. 20.2%, p=0.001) and readmission risk (odds ratio, 1.57; 95% confidence interval [CI], 1.15–2.16, p=0.005). However, subgroup analysis revealed extended PLND significantly improved RFS in patients with p/cRNU (hazard ratio, 0.54; 95% CI, 0.38–0.77; p<0.001).Conclusion: Extended PLND does not provide survival benefits for overall patient population and increases readmission risk but significantly improves RFS in patients with p/cRNU. Tailoring PLND extent based on upper tract disease status is recommended.

Journal of Urologic OncologyVol. 23(1)
Ulsan College (KR), Yonsei University (KR), Korea University (KR), Asan Medical Center (KR), Samsung Medical Center (KR), Seoul National University Hospital (KR), Seoul National University Bundang Hospital (KR), Kyungpook National University (KR), University of Ulsan (KR), Sungae Hospital (KR), Pusan National University Hospital (KR), National Cancer Center (KR), Gwangmyeong Mental Health Welfare Center (KR), Gangneung Asan Hospital (KR), Pusan National University Yangsan Hospital (KR), Chung-Ang University Hospital (KR), Sungkyunkwan University (KR)
Samsung
Openalex Percentile: Top 18%
Bladder and Urothelial Cancer Treatments
2.01
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