You have accessJournal of UrologyBladder Cancer: Invasive III1 Apr 20121756 STAGE SPECIFIC IMPACT OF EXTENDED VERSUS STANDARD PELVIC LYMPH NODE DISSECTION IN RADICAL Giuseppe Simone, Rocco Papalia, Mariaconsiglia Ferriero, Salvatore Guaglianone, Devis Collura, Emanuele Castelli, Giovanni Muto, and Michele Gallucci Giuseppe SimoneGiuseppe Simone Rome, Italy More articles by this author , Rocco PapaliaRocco Papalia Rome, Italy More articles by this author , Mariaconsiglia FerrieroMariaconsiglia Ferriero Rome, Italy More articles by this author , Salvatore GuaglianoneSalvatore Guaglianone Rome, Italy More articles by this author , Devis ColluraDevis Collura Turin, Italy More articles by this author , Emanuele CastelliEmanuele Castelli Turin, Italy More articles by this author , Giovanni MutoGiovanni Muto Turin, Italy More articles by this author , and Michele GallucciMichele Gallucci Rome, Italy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1772AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate the impact of an extended versus a standard pelvic lymph-node dissection (PLND) on disease-free survival (DFS) and cancer-specific survival (CSS) of patients with non-metastatic muscle invasive urothelial carcinoma (UC) of the bladder treated with radical cystectomy (RC). METHODS We retrospectively analyzed data of 1400 patients collected in two prospectively-maintained institutional databases between 2001 and 2010. Standard PLND (s-PLND) had the upper boundary at the iliac bifurcation while extended PLND (e-PLND) included the presacral and the common iliac nodes. Patients who met inclusion criteria (non-metastatic high-grade UC, not undergone neoadjuvant treatments, patients receiving e-PLND or s-PLND) were included in analysis. Univariable and multivariable Cox regression analyses was performed to identify independent predictors of DFS and CSS and, subsequently, the effect of e-PLND on DFS and CSS after stratifying according to pathological Tumor (pT) and Nodal (pN) stage was determined with a multivariable Cox analysis. RESULTS In 971 patients who met inclusion criteria, significant predictors of DFS and CSS (p<0.05) were age, pT, pN, number of nodes removed and extent of PLND at univariable analysis and pT, pN and extent of PLND at multivariable analysis (all p<0.001). At multivariable analysis, the benefit of an e-PLND on DFS and CSS was significant across all pT stages (all p<0.05) and across all pN stages (pN=0: p=0.011 and p=0.034 for DFS and CSS, respectively; pN1 and pN2: both p<0.001). Table 1. Table 1. Multivariable Cox regression analysis predicting DFS and CSS of 961 patients treated with Radical Cystectomy and PLND stratifying according to 2009 pT and pN stage Disease Free Survival Cancer Specific Survival HR 95% CI p HR 95% CI p pT Stage⁎ pT0-a-is-1-2 s-PLND 1 - - 1 - - pT0-a-is-1-2 e-PLND 0.43 0.24 to 0.76 0.003 0.36 0.17 to 0.78 0.006 pT3-4 s-PLND 1 - - 1 - - pT3-4 e-PLND 0.51 0.38 to 0.68 <0.001 0.58 0.41 to 0.82 0.001 pN0 s-PLND 1 - - 1 - - pN0 e-PLND 0.63 0.44 to 0.91 0.011 0.54 0.3 to 0.95 0.034 pN Stage⁎⁎ pN1 s-PLND 1 - - 1 - - pN1 e-PLND 0.19 0.08 to 0.49 <0.001 0.15 0.05 to 0.41 <0.001 pN2 s-PLND 1 - - 1 - - pN2 e-PLND 0.4 0.24 to 0.67 <0.001 0.45 0.25 to 0.8 0.004 ⁎ Adjusted to age and pN stage ⁎⁎ Adjusted to age and pT stage CONCLUSIONS The staging accuracy and the survival benefit provided by e-PLND suggest to consider this template as the standard procedure for muscle-invasive UC treated with RC. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e708-e709 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giuseppe Simone Rome, Italy More articles by this author Rocco Papalia Rome, Italy More articles by this author Mariaconsiglia Ferriero Rome, Italy More articles by this author Salvatore Guaglianone Rome, Italy More articles by this author Devis Collura Turin, Italy More articles by this author Emanuele Castelli Turin, Italy More articles by this author Giovanni Muto Turin, Italy More articles by this author Michele Gallucci Rome, Italy More articles by this author Expand All Advertisement Advertisement Loading ...