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Impact of the extent of lymph node dissection on survival outcomes in clinically lymph node-positive bladder cancer
M. von Deimling, M. Furrer, LS. Mertens, A. Mari, N. van Ginkel, M. Bacchiani, M. Maas, R. Pichler, R. Li, M. Moschini, A. Bianchi, MW. Vetterlein, C. Lonati, F. Crocetto, J. Taylor, KH. Tully, L. Afferi, F. Soria, F. Del Giudice, M. Longoni, E....
Jazyk angličtina Země Anglie, Velká Británie
Typ dokumentu multicentrická studie, časopisecké články
NLK
Free Medical Journals
od 1999
Medline Complete (EBSCOhost)
od 1999-01-01 do Před 1 rokem
PubMed
37904652
DOI
10.1111/bju.16210
Knihovny.cz E-zdroje
- MeSH
- cystektomie MeSH
- lidé MeSH
- lokální recidiva nádoru * patologie MeSH
- lymfadenektomie MeSH
- lymfatické uzliny chirurgie patologie MeSH
- nádory močového měchýře * farmakoterapie chirurgie MeSH
- retrospektivní studie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
OBJECTIVE: To determine the oncological impact of extended pelvic lymph node dissection (ePLND) vs standard PLND (sPLND) during radical cystectomy (RC) in clinically lymph node-positive (cN+) bladder cancer (BCa). PATIENTS AND METHODS: In this retrospective, multicentre study we included 969 patients who underwent RC with sPLND (internal/external iliac and obturator lymph nodes) or ePLND (sPLND plus common iliac and presacral nodes) with or without platin-based peri-operative chemotherapy for cTany N1-3 M0 BCa between 1991 and 2022. We assessed the impact of ePLND on recurrence-free survival (RFS) and the distribution of recurrences (locoregional and distant recurrences). The secondary endpoint was overall survival (OS). We performed propensity-score matching using covariates associated with the extent of PLND in univariable logistic regression analysis. The association of the extent of PLND with RFS and OS was investigated using Cox regression models. RESULTS: Of 969 cN+ patients, 510 were 1:1 matched on propensity scores. The median (interquartile range [IQR]) time to recurrence was 8 (4-16) months, and median (IQR) follow-up of alive patients was 30 (13-51) months. Disease recurrence was observed in 104 patients in the ePLND and 107 in the sPLND group. Of these, 136 (27%), 47 (9.2%) and 19 patients (3.7%) experienced distant, locoregional, or both distant and locoregional disease recurrence, respectively. When stratified by the extent of PLND, we did not find a difference in recurrence patterns (P > 0.05). ePLND improved neither RFS (hazard ratio [HR] 0.91, 95% confidence interval [CI] 0.70-1.19; P = 0.5) nor OS (HR 0.78, 95% CI 0.60-1.01; P = 0.06) compared to sPLND. Stratification by induction chemotherapy did not change outcomes. CONCLUSION: Performing an ePLND at the time of RC in cN+ patients improved neither RFS nor OS compared to sPLND, regardless of induction chemotherapy status. Pretreatment risk stratification is paramount to identify ideal candidates for RC with ePLND as part of a multimodal treatment approach.
Department of Genitourinary Oncology H Lee Moffitt Cancer Center and Research Institute Tampa FL USA
Department of Urologic Sciences University of British Columbia Vancouver BC Canada
Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic
Department of Urology and Neurourology Marien Hospital Herne Ruhr University Bochum Herne Germany
Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria
Department of Urology Eberhard Karls University Tübingen Tübingen Germany
Department of Urology Luzerner Kantonsspital Luzern Switzerland
Department of Urology Solothurner Spitäler AG Olten Solothurn Switzerland
Department of Urology Spedali Civili of Brescia Brescia Italy
Department of Urology The Netherlands Cancer Institute Amsterdam The Netherlands
Department of Urology University Hospital of Bern University of Bern Bern Switzerland
Department of Urology University Medical Center Hamburg Eppendorf Hamburg Germany
Department of Urology University of Texas Southwestern Dallas TX USA
Department of Urology University of Verona Azienda Ospedaliera Universitaria Integrata Verona Italy
Department of Urology Urological Research Institute Milan Italy
Department of Urology Urosud La Croix Du Sud Hospital Quint Fonsegrives France
Department of Urology Weill Cornell Medical College New York NY USA
Hourani Center for Applied Scientific Research Al Ahliyya Amman University Amman Jordan
Karl Landsteiner Institute of Urology and Andrology Vienna Austria
Citace poskytuje Crossref.org
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