LEVEL OF NODAL METASTASIS IN PATIENTS UNDERGOING RADICAL CYSTECTOMY AND LYMPHADENECTOMY: IS THERE A ROLE OF EXTENDED LYMPHADENECTOMY IN THE POST-S1011 ERA?

IF 2.4 3区医学 Q3 ONCOLOGY

Urologic Oncology-seminars and Original Investigations Pub Date : 2025-03-01 DOI:10.1016/j.urolonc.2024.12.048

Leilei Xia, Anosh Dadabhoy, Luis Santos Molina, Erika Wood, Yeonsoo Lee, Gus Miranda, Jie Cai, Hooman Djaladat, Anne Schuckman, Siamak Daneshmand

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引用次数: 0

Abstract

Introduction

S1011 trial showed no benefits of extended lymphadenectomy (ELND) compared to standard LND (SLND) in patients with muscle-invasive bladder cancer (MIBC) undergoing radical cystectomy (RC). Debate still exists regarding the role of ELND in selected patients. We aim to investigate the impact of level of nodal metastasis (N+) on outcomes and rate of skip nodal metastases.

Methods

Using our IRB approved perspective institutional database, we identified patients with cT2-4aN0M0 urothelial cancer who underwent RC and super-extended LND +/- neoadjuvant chemotherapy (NAC) between 2002 and 2023. Level of LNs were divided into 3 levels (Figure 1): level 1 – external/internal iliac, and obturator LNs (SLND); level 2 - common iliac, pre-sciatic, and pre-sacral LNs (ELND); level 3 - paraaortic and paracaval LNs (ELND) The cohort was stratified into three groups based on the highest level of N+. Skip N+ was defined as having level 2 or 3 N+ without having lower-level positive nodes.

Results

A total of 738 patients were included and N+ was seen in 159 (21.5%) patients. Among patients with N+, 100 (62.9%) had highest/only N+ at level 1, 22 (13.8%) had highest N+ at level 2, and 37 (23.3%) had highest N+ at level 3 (Figure 2). Only 7 (4.4%) patients had skip N+ including 3 (1.9%) skip level 2 and 4 (2.5%) skip level 3. Two-year (2-y) recurrence free survival (RFS) for node negative, level 1, level 2, and level 3 N+ was 81%, 52%, 36%, and 23%, respectively and 2-y overall survival (OS) were 82%, 60%, 49%, and 27%, respectively. For patients with level 1 N+ who did not receive peri-operative chemotherapy (n=38), 2-y RFS was 45% and 2-y OS was 43%. However, for patients with higher level (2-3) N+ who did not receive peri-operative chemotherapy (n=16), 14 (88%) died within 2 years and 10 (63%) died within 1 year.

Conclusions

The therapeutic benefit of ELND is very small for patients with higher level of N+ due to the poor prognosis without chemotherapy. The incidence of skip N+ is low and diagnostic benefit of ELND may also be limited. The role of ELND in the post-S1011 era may be very limited and further prospective studies are needed to identify if any MIBC patients benefit from ELND.

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根治性膀胱切除术和淋巴结切除术患者的淋巴结转移水平：扩大淋巴结切除术在后911时代是否有作用？

2010年的一项试验显示，在接受根治性膀胱切除术（RC）的肌肉浸润性膀胱癌（MIBC）患者中，与标准淋巴结切除术（SLND）相比，扩展淋巴结切除术（ELND）没有益处。关于ELND在特定患者中的作用仍存在争议。我们的目的是研究淋巴结转移水平（N+）对预后和跳过淋巴结转移率的影响。方法使用我们的IRB批准的前瞻性机构数据库，我们确定了2002年至2023年间接受RC和超扩展LND +/-新辅助化疗（NAC）的cT2-4aN0M0尿路上皮癌患者。ln水平分为3个水平（图1）：水平1 -髂外/内，和闭孔ln (SLND)；2级-髂、坐骨前和骶骨前的常见ln (ELND)；level 3 - paraortic and paracaval LNs （ELND）根据N+的最高水平将队列分为三组。跳过N+被定义为具有2级或3级N+而没有较低级别的正节点。结果共纳入738例患者，其中N+ 159例（21.5%）。在N+患者中，有100例（62.9%）患者最高或仅为1级N+， 22例（13.8%）患者最高为2级N+， 37例（23.3%）患者最高为3级N+（图2）。仅有7例（4.4%）患者跳过N+，其中3例（1.9%）跳过2级，4例（2.5%）跳过3级。淋巴结阴性、1级、2级和3级N+的2年（2-y）无复发生存率（RFS）分别为81%、52%、36%和23%，2-y总生存率（OS）分别为82%、60%、49%和27%。对于未接受围手术期化疗的1级N+患者（N =38）， 2-y RFS为45%，2-y OS为43%。然而，较高（2-3）N+水平且未接受围手术期化疗的患者（N =16）， 2年内死亡14例（88%），1年内死亡10例（63%）。结论对于N+水平较高的患者，如果不进行化疗，预后较差，ELND的治疗效果很小。跳跃性N+的发生率较低，ELND的诊断价值也有限。ELND在s1011后时代的作用可能非常有限，需要进一步的前瞻性研究来确定是否有任何MIBC患者从ELND中获益。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Urologic Oncology-seminars and Original Investigations 医学-泌尿学与肾脏学

CiteScore

4.80

自引率

3.70%

发文量

297

审稿时长

7.6 weeks

期刊介绍： Urologic Oncology: Seminars and Original Investigations is the official journal of the Society of Urologic Oncology. The journal publishes practical, timely, and relevant clinical and basic science research articles which address any aspect of urologic oncology. Each issue comprises original research, news and topics, survey articles providing short commentaries on other important articles in the urologic oncology literature, and reviews including an in-depth Seminar examining a specific clinical dilemma. The journal periodically publishes supplement issues devoted to areas of current interest to the urologic oncology community. Articles published are of interest to researchers and the clinicians involved in the practice of urologic oncology including urologists, oncologists, and radiologists.