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

Marina Kosiba; L Franziska Stolzenbach; Claudia Collà Ruvolo; Luigi Nocera; Mila Mansour; Zhe Tian; Frederik C Roos; Andreas Becker; Luis A Kluth; Derya Tilki; Shahrokh F Shariat; Fred Saad; Felix K H Chun; Pierre I Karakiewicz

doi:10.1016/j.clgc.2021.10.010

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

Clin Genitourin Cancer. 2022 Apr;20(2):195.e1-195.e8. doi: 10.1016/j.clgc.2021.10.010. Epub 2021 Nov 5.

Authors

Affiliations

¹ Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada. Electronic address: Marina.Kosiba@kgu.de.
² Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
³ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, University of Naples Federico II, Naples, Italy.
⁴ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy.
⁵ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
⁶ Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany.
⁷ Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
⁸ Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia; Department of Urology, University of Jordan, Amman, Jordan.

PMID: 34906434
DOI: 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 T_1-2 or T_3-4 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 T_1-2 or T_3-4 VHBC patients. Conversely, PLND extent was associated with lower CSM in T_1-2, as well as in T_3-4 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 T_3-4 VHBC (Odds ratio [OR] 1.01, P = .001), stage T_1-2 UCUB (OR 1.01, P < .001) and T_3-4 UCUB (OR 1.01, P < .001), but not in stage T_1-2 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: Adenocarcinoma; Bladder cancer; Extended lymph node dissection; Neuroendocrine carcinoma; Number of nodes removed; Squamous cell carcinoma; annual treatment rates; extensive lymph node dissection.

MeSH terms

Carcinoma, Transitional Cell* / pathology
Cystectomy / methods
Humans
Lymph Node Excision / methods
Lymph Nodes / pathology
SEER Program
Treatment Outcome
Urinary Bladder / pathology
Urinary Bladder Neoplasms* / pathology