Role of lymph node dissection in radical cystectomy

Keyi Wang; Heng Shi; Weipu Mao; Lei Yin; Guangchun Wang; Donglai Fan; Jinbo Xie; Weiyi Li; Bo Peng

doi:10.3892/ol.2020.11563

Role of lymph node dissection in radical cystectomy

Oncol Lett. 2020 Jul;20(1):409-419. doi: 10.3892/ol.2020.11563. Epub 2020 Apr 21.

Authors

Keyi Wang¹, Heng Shi^{1

2}, Weipu Mao¹, Lei Yin¹, Guangchun Wang¹, Donglai Fan¹, Jinbo Xie¹, Weiyi Li¹, Bo Peng^{1

3}

Affiliations

¹ Department of Urology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai 200072, P.R. China.
² Department of Urology, Shanghai Tenth People's Hospital, Nanjing Medical University, Nanjing, Jiangsu 210011, P.R. China.
³ Department of Urology, Putuo People's Hospital of Tongji University, Shanghai 200060, P.R. China.

Abstract

The number of lymph node dissections (LNDs) is an independent factor influencing the survival time of patients with bladder cancer (BCa) after radical resection (RC). The present study aimed to investigate the association between the number of LNDs and the survival of patients with BCa at different stages and who underwent RC in the United States of America and China. Records from 17,730 American patients with BCa and 158 Chinese patients with BCa were collected from the Surveillance, Epidemiology and End Results (SEER) and the Shanghai Tenth People's Hospital (China) databases, respectively. Kaplan-Meier curve and χ² test were used to determine the overall survival time (OS) of patients with BCa. Cox regression analysis was used to analyze the effects of LND number on OS. Overall, 13,421 (75.7%) patients were negative for lymph node metastasis (N0) and 4,309 (24.3%) were positive for lymph node metastasis (N+) among the 17,730 American patients with BCa. In the group of 158 Chinese patients, 125 (79.1%) were N0 and 33 (20.9%) were N+. In the American patients, the median number of dissected nodes was 11.0 [interquartile range (IQR)=3.0-21.0] for N0 patients and 14.0 (IQR=8.0-23.0) for N+ patients. The median number of LNDs was 5.0 (IQR=2.0-7.0) for Chinese N0 patients and 5.0 (IQR=1.5-10.5) for Chinese N+ patients. The number of LNDs may therefore be an independent factor associated with survival in patients who underwent RC. Furthermore, a higher number of LNDs was associated with longer OS in patients with BCa [American patients, ≥13 nodes vs. ≤5 nodes, hazard ratio (HR)=0.62, 95% confidence interval (CI)=0.59-0.65, P<0.001; Chinese patients, ≥5 nodes vs. ≤1 node, HR=0.27, 95% CI=0.12-0.62, P=0.002]. The number of LNDs in patients with BCa and N+ was higher compared with number of LNDs in patients with BCa and N0 who underwent RC. More extensive LND improved the OS in both the patients from USA and China. Increasing the number of LNDs may therefore be crucial when treating patients with BCa.

Keywords: Epidemiology and End Results; Surveillance; bladder cancer; lymph node dissection; overall survival; radical cystectomy.