Abstract
PurposeAdding pelvic lymph node dissection (PLND) to cystectomy offers significant survival benefit. However, it remains unclear whether this benefit persists in all histologic types. The aim of the study was to examine the impact of PLND on overall survival (OS) after cystectomy in bladder carcinoma patients with histological variants.MethodsWithin the Surveillance, Epidemiology and End Results database, we identified 16,880 bladder carcinoma patients receiving cystectomy between 2004 and 2015. Patients were stratified according to the following histologic types: transitional cell carcinoma, squamous cell carcinoma, adenocarcinoma, small cell carcinoma, neuroendocrine carcinoma, signet ring cell carcinoma, pseudosarcomatous carcinoma, and other histology. Cox regression models were used to evaluate the effect of PLND on OS stratified by histologic type.ResultsHistologic types were significantly associated with the presence of lymph node metastasis in patients with bladder carcinoma (P < 0.001). In multivariable Cox regression analyses, PLND compared with non-PLND was associated with OS benefit in patients with transitional cell carcinoma (hazard ratio [HR], 0.595; 95% confidence interval [95% CI], 0.557–0.634 [P < 0.001]), squamous cell carcinoma (HR, 0.646; 95% CI, 0.494–0.846 [P = 0.002]), and signet ring cell carcinoma (HR, 0.233; 95% CI, 0.107–0.504 [P < 0.001]), whereas no significant differences in OS were observed in other histological subsets.DiscussionOur analyses revealed a significant OS benefit from PLND in patients with transitional cell carcinoma, squamous cell carcinoma, and signet ring cell carcinoma. However, a survival benefit of PLND in patients with other histologic types was not demonstrated.
Highlights
Bladder carcinoma is one of the most common cancers worldwide, with an estimated 81,400 new patients diagnosed in the United States in 2020 [1]
Patients were stratified according to the following histologic types: transitional cell carcinoma, squamous cell carcinoma, adenocarcinoma, small cell carcinoma, neuroendocrine carcinoma, signet ring cell carcinoma, pseudosarcomatous carcinoma, and other histology
Adjusted multivariable Cox regression analyses demonstrated a significant OS benefit for cystectomy and pelvic lymph node dissection (PLND) in patients with transitional cell carcinoma (HR, 0.595; 95% CI, 0.557– 0.634 [P < 0.001]), squamous cell carcinoma (HR, 0. 646; 95% CI, 0.494–0.846 [P = 0.002]), and signet ring cell carcinoma (HR, 0.233; 95% CI, 0.107–0.504 [P < 0.001]) compared with patients undergoing cystectomy only
Summary
Bladder carcinoma is one of the most common cancers worldwide, with an estimated 81,400 new patients diagnosed in the United States in 2020 [1]. Almost 25% of bladder cancer patients receiving cystectomy have lymph node invasion [4]. Increasing evidence suggests that adding pelvic lymph node dissection (PLND) to cystectomy provides considerable benefits, which are emphasized by providing accurate nodal staging and reducing disease burden [5, 6]. Urothelial (transitional cell) carcinoma is the most common pathological type, non-urothelial variants are observed in up to a quarter of patients and represent a rare and challenging group [7,8,9]. Non-urothelial histologic types have been associated with biologically aggressive disease and unfavorable survival outcomes compared with urothelial carcinoma of the bladder [7,8,9]. Evidence concerning PLND in bladder cancer patients with non-urothelial histological variants is limited and inconsistent
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