Association of Perioperative Factors with Lymph Node Positivity in Bladder Cancer Following Radical Cystectomy

Introduction and objectives: The treatment of bladder carcinoma relies on a multimodal approach, including chemotherapy, radical cystectomy, and lymph node dissection, but clear guidelines for the optimal strategy remain ambiguous. Radical cystectomy is complex, with high morbidity and mortality, yet limited research has focused on its short-term implications for lymph node-positive bladder cancer. This study aims to address these gaps by identifying perioperative factors linked to lymph node positivity and comparing outcomes between lymph node-positive and negative patients. Methods: We conducted a retrospective analysis of 4382 bladder cancer patients who underwent radical cystectomy, collecting comprehensive clinical and surgical data. Clinical features included demographic information and past medical history, while surgical features encompassed operation time, major complications, and post-operative recovery. The cohort was divided into lymph node-negative and lymph node-positive groups based on pathological analysis. Logistic regression was used to identify predictors associated with lymph node status, and statistical significance of these associations was calculated using odds ratios (ORs), 95% confidence intervals (CIs), and p-values. Results: A total of 990 patients (22.9%) were reported to have lymph-node positive bladder cancer after radical cystectomy. Logistic regression analyses revealed that a longer total hospital stay was significantly associated with increased odds of lymph node positivity (OR 1.07, CI: 1.03-1.13, p = 0.002), indicating a correlation between extended hospitalization and more advanced disease. Conversely, a greater number of days from operation to discharge was associated with decreased odds of lymph node positivity (OR 0.93, CI: 0.89-0.97, p = 0.002), suggesting that prolonged postoperative recovery was not indicative of lymphatic spread. Additionally, patients who received chemotherapy within 90 days before surgery had higher odds of lymph node positivity (OR 1.17, CI: 1.01-1.35, p = 0.037), highlighting a link between preoperative treatment and aggressive disease characteristics. Major complications during surgery and prolonged operative time were not found to be significantly associated with lymph node-positive disease. Conclusions: Our findings highlight key perioperative predictors of lymph node positivity in bladder cancer, emphasizing the importance of thorough preoperative assessment and personalized treatment planning. Despite the benefits of neoadjuvant chemotherapy, some patients still present with lymph node-positive disease, underscoring the need for optimized management strategies such as follow-up imaging and the use of adjuvant chemotherapy.