MP46-19 THE ROLE OF EXTENDED VERSUS STANDARD LYMPHADENECTOMY LYMPH NODE DISSECTION IN CLINICALLY LYMPH NODE-POSITIVE BLADDER CANCER

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP46-19 THE ROLE OF EXTENDED VERSUS STANDARD LYMPHADENECTOMY LYMPH NODE DISSECTION IN CLINICALLY LYMPH NODE-POSITIVE BLADDER CANCER Markus Von Deimling, Andrea Mari, Alberto Bianchi, Moritz Maas, Renate Pichler, Malte W. Vetterlein, Francesco Del Giudice, Karl H. Tully, Luca Afferi, Marco Moschini, Ekaterina Laukhtina, Michael Rink, Shahrokh F. Shariat, and Benjamin Pradere Markus Von DeimlingMarkus Von Deimling More articles by this author , Andrea MariAndrea Mari More articles by this author , Alberto BianchiAlberto Bianchi More articles by this author , Moritz MaasMoritz Maas More articles by this author , Renate PichlerRenate Pichler More articles by this author , Malte W. VetterleinMalte W. Vetterlein More articles by this author , Francesco Del GiudiceFrancesco Del Giudice More articles by this author , Karl H. TullyKarl H. Tully More articles by this author , Luca AfferiLuca Afferi More articles by this author , Marco MoschiniMarco Moschini More articles by this author , Ekaterina LaukhtinaEkaterina Laukhtina More articles by this author , Michael RinkMichael Rink More articles by this author , Shahrokh F. ShariatShahrokh F. Shariat More articles by this author , and Benjamin PradereBenjamin Pradere More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003292.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The appropriate extent of lymph node dissection (LND) at radical cystectomy for bladder cancer (BCa) is still controversial. In particular, patients with clinical evidence of locoregional lymph node metastasis (cN+) may benefit from an extended LND. In this study, we investigated the effect of extended versus standard LND on survival outcomes in patients with cN+ BCa. METHODS: We queried our retrospective, multi-institutional database to identify all patients who underwent upfront RC with standard (internal, external iliac, and obturator lymph nodes) or extended LND (additionally common iliac and presacral lymph nodes) for cT2-4N1-3M0 BCa. We excluded censored patients with a follow-up <3 months and all patients who received preoperative chemotherapy. The primary objective was to assess recurrence-free survival (RFS) after RC and the distribution of recurrences (local vs. distant). Secondary endpoints comprised overall (OM) and cancer-specific mortality (CSM). The Kaplan-Meier method and cumulative incidence curves accounting for competing risks were used to delineate survival outcomes graphically. We assessed the impact of the LND template on RFS, OM, and CSM on uni- and multivariable regression analyses. This study was IRB-approved (ref. no. 1480/2022). RESULTS: Of 370 patients, 232 underwent standard and 138 extended LND. In total, 182 experienced cancer recurrence, 190 died with 140 dying from BCa. Median follow-up of patients alive was 32 months, and median time to recurrence was 8 months. Patients who underwent an extended LND were significantly younger (mean 73 vs. 68 years, p=0.001), had more frequent cN3-stage (1.7% vs. 9.4%), and more positive lymph nodes removed (median 1.0 vs. 2.0, p=0.02). 114 patients received adjuvant treatment with no difference between LND groups. There was no difference in the distribution of recurrences (in total, 32 locoregional, 103 distant, and 18 both) between the groups. On survival analyses, we did not find a difference in RFS (p=0.17), OM (p=0.91), or CSM (p=0.07) when stratified by the LND template. On multivariable analyses, adjusted for age, gender, comorbidities, pathological T- and N-stage, type of urinary diversion, surgical margins, and receipt of adjuvant treatment, the LND template was not independently associated with survival outcomes. CONCLUSIONS: In patients with cN+ BCa, extended LND did not results in an improved RFS, OM, or CSM compared to standard LND. The results of the ongoing prospective SWOG 1101 trial are urgently awaited. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e640 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Markus Von Deimling More articles by this author Andrea Mari More articles by this author Alberto Bianchi More articles by this author Moritz Maas More articles by this author Renate Pichler More articles by this author Malte W. Vetterlein More articles by this author Francesco Del Giudice More articles by this author Karl H. Tully More articles by this author Luca Afferi More articles by this author Marco Moschini More articles by this author Ekaterina Laukhtina More articles by this author Michael Rink More articles by this author Shahrokh F. Shariat More articles by this author Benjamin Pradere More articles by this author Expand All Advertisement PDF downloadLoading ...