Advertisement

Contemporary Trends and Efficacy of Pelvic Lymph Node Dissection at Radical Cystectomy for Urothelial and Variant Histology Carcinoma of the Urinary Bladder

Published:November 05, 2021DOI:https://doi.org/10.1016/j.clgc.2021.10.010

      Abstract

      Objective

      To test 1) contemporary pelvic lymph node dissection (PLND) trends at radical cystectomy (RC) in variant histology bladder cancer (VHBC) patients and urothelial carcinoma of the urinary bladder (UCUB), as well as 2) to test the effect of PLND extent on cancer specific mortality (CSM) after RC.

      Methods

      Within the Surveillance, Epidemiology and End Results Registry (SEER, 2004-2016), we identified non-metastatic stage T1-2 or T3-4 VHBC and UCUB patients, who underwent RC. CSM and lymph node invasion (LNI) rates were stratified according to PLND extent, as well as coded continuously in multivariate Cox and logistic regression models.

      Results

      Of 19,020 patients, 1736 (9.1%) were coded as having VHBC (46.9% squamous cell carcinoma, 22.5% adenocarcinoma, 18.9% neuroendocrine carcinoma, 11.7% not otherwise specified) vs 17,284 (90.9%) UCUB. PLND was performed in 80.1 of VHBC vs. 83.5% UCUB patients. In both histological groups, PLND rates increased over time (70.9-89.6% and 76.2%-90.1%, both P < .01). PLND extent did not significantly affect CSM in stage T1-2 or T3-4 VHBC patients. Conversely, PLND extent was associated with lower CSM in T1-2, as well as in T3-4 UCUB patients, which was confirmed in multivariate Cox analyses (Hazard ratio [HR] 0.99, P < .001). Rates of LNI increased with extent of PLND in logistic regression analyses in stage T3-4 VHBC (Odds ratio [OR] 1.01, P = .001), stage T1-2 UCUB (OR 1.01, P < .001) and T3-4 UCUB (OR 1.01, P < .001), but not in stage T1-2 VHBC (OR 1.01, P = .3).

      Conclusion

      PLND rates do not differ between VHBC and UCUB patients. A potential survival benefit related to more extensive PLND is operational in UCUB patients, but not in VHBC patients.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Genitourinary Cancer
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Network NCC. NCCN Guidelines Version 6.2020 Bladder Cancer [Available from: https://www.nccn.org/professionals/physician_gls/PDF/bladder.pdf.

        • Alfred Witjes J
        • Lebret T
        • Comperat EM
        • et al.
        Updated 2016 EAU guidelines on muscle-invasive and metastatic bladder cancer.
        European urol. 2017; 71: 462-475
        • Gschwend JE
        • Heck MM
        • Lehmann J
        • et al.
        Extended versus limited lymph node dissection in bladder cancer patients undergoing radical cystectomy: survival results from a prospective, randomized trial.
        Eur urol. 2019; 75: 604-611
        • Leissner J
        • Hohenfellner R
        • Thuroff JW
        • Wolf HK.
        Lymphadenectomy in patients with transitional cell carcinoma of the urinary bladder; significance for staging and prognosis.
        BJU international. 2000; 85: 817-823
        • May M
        • Herrmann E
        • Bolenz C
        • et al.
        Association between the number of dissected lymph nodes during pelvic lymphadenectomy and cancer-specific survival in patients with lymph node–negative urothelial carcinoma of the bladder undergoing radical cystectomy.
        Ann Surg Oncol. 2011; 18: 2018-2025
        • Howlader N
        • Noone A
        • Krapcho M
        • et al.
        SEER Cancer Statistics Review, 1975-2016.
        National Cancer Institute, Bethesda, MD2018 (based on November 2018 SEER data submission, posted to the SEER web site, April 2019)
        • Humphrey PA
        • Moch H
        • Cubilla AL
        • Ulbright TM
        • Reuter VE.
        The 2016 WHO classification of tumours of the urinary system and male genital organs-part B: prostate and bladder tumours.
        European urol. 2016; 70: 106-119
        • Cole AP
        • Dalela D
        • Hanske J
        • i TK
        • Meyer CP
        • et al.
        Temporal trends in receipt of adequate lymphadenectomy in bladder cancer 1988 to 2010.
        Urologic oncology. 2015; 33 (.e9-17): 504
        • Mistretta FA
        • Mazzone E
        • Knipper S
        • et al.
        Contemporary trends of pelvic lymph node dissection at radical cystectomy for urothelial carcinoma of urinary bladder and associated cancer specific mortality and complications: comparison between octogenarian versus younger patients.
        Cancer Epidemiol. 2019; 59: 135-142
        • Koppie TM
        • Vickers AJ
        • Vora K
        • Dalbagni G
        • Bochner BH.
        Standardization of pelvic lymphadenectomy performed at radical cystectomy: can we establish a minimum number of lymph nodes that should be removed?.
        Cancer. 2006; 107: 2368-2374
        • Mazzone E
        • Preisser F
        • Nazzani S
        • Tian Z
        • Fossati N
        • Gandaglia G
        • et al.
        More Extensive Lymph Node Dissection Improves Survival Benefit of Radical Cystectomy in Metastatic Urothelial Carcinoma of the Bladder.
        Clin Genitourin Cancer. 2019; 17 (-13.e2): 105
        • Abol-Enein H
        • Tilki D
        • Mosbah A
        • El-Baz M
        • Shokeir A
        • Nabeeh A
        • et al.
        Does the extent of lymphadenectomy in radical cystectomy for bladder cancer influence disease-free survival? A prospective single-center study.
        European urology. 2011; 60: 572-577
        • Simone G
        • Papalia R
        • Ferriero M
        • Guaglianone S
        • Castelli E
        • Collura D
        • et al.
        Stage-specific impact of extended versus standard pelvic lymph node dissection in radical cystectomy.
        Int j u official j Japanese Urological Association. 2013; 20: 390-397
        • Bruins HM
        • Veskimae E
        • Hernandez V
        • Imamura M
        • Neuberger MM
        • Dahm P
        • et al.
        The impact of the extent of lymphadenectomy on oncologic outcomes in patients undergoing radical cystectomy for bladder cancer: a systematic review.
        Eur urol. 2014; 66: 1065-1077
        • Shariat SF
        • Rink M
        • Ehdaie B
        • Xylinas E
        • Babjuk M
        • Merseburger AS
        • et al.
        Pathologic nodal staging score for bladder cancer: a decision tool for adjuvant therapy after radical cystectomy.
        Eur urol. 2013; 63: 371-378
        • Gofrit ON
        • Zorn KC
        • Steinberg GD
        • Zagaja GP
        • Shalhav AL.
        The Will Rogers phenomenon in urological oncology.
        J Urol. 2008; 179: 28-33
        • Abufaraj M
        • Shariat SF
        • Foerster B
        • Pozo C
        • Moschini M
        • D'Andrea D
        • et al.
        Accuracy and prognostic value of variant histology and lymphovascular invasion at transurethral resection of bladder.
        World j ur. 2018; 36: 231-240
        • Kim HS
        • Moon KC
        • Jeong CW
        • Kwak C
        • Kim HH
        • Ku JH.
        Histological variant as the significant predictor of survival in patients with lymph node positive urothelial carcinoma of the bladder.
        Sci Rep. 2015; 5: 9626
        • VANB S
        • Costello AJ
        • VANP H
        Prognosis of node-positive bladder cancer in 2016.
        Minerva Urol Nefrol. 2016; 68: 125-137
        • Rice KR
        • Koch MO
        • Kao CS
        • et al.
        Lymph node metastases in patients with urothelial carcinoma variants: influence of the specific variant on nodal histology.
        Urologic oncology. 2015; 33: 20.e3-20.e9
        • Marks P
        • Gild P
        • Soave A
        • et al.
        The impact of variant histological differentiation on extranodal extension and survival in node positive bladder cancer treated with radical cystectomy.
        Surg Oncol. 2019; 28: 208-213
        • Davies JD
        • Simons CM
        • Ruhotina N
        • Barocas DA
        • Clark PE
        • Morgan TM.
        Anatomic basis for lymph node counts as measure of lymph node dissection extent: a cadaveric study.
        Urology. 2013; 81: 358-363