Impact of lymph-node dissection during radical cystectomy for non-muscle-invasive bladder cancer: Japanese multicenter retrospective study.

Abstract

Background: There is no definitive consensus on the necessity and impact of lymph-node dissection during radical cystectomy for non-muscle-invasive bladder cancer (NMIBC). This study aimed to evaluate the prognostic significance of lymph-node dissection in NMIBC and identify preoperative factors influencing non-urinary tract recurrence-free survival (NUTRFS).

Methods: We retrospectively analyzed data for 2674 cases of bladder cancer treated with radical cystectomy between January 2013 and December 2019 from a multicenter Japanese database; 410 patients were preoperatively diagnosed with NMIBC. Patients were divided into lymph-node dissection and non-lymph-node dissection groups, and NUTRFS and overall survival were compared as endpoints. Univariate and multivariate analyses were performed to determine NUTRFS prognostic factors.

Results: Lymph-node dissection was performed in 374/410 patients and not in 36/410. Compared with the lymph-node dissection group, the non-lymph-node dissection group was older, and had a lower proportion of a performance status of 0 and a higher proportion of clinical stage < T1 disease. The pathological lymph-node positivity rate in the lymph-node dissection group was 6.9%. However, lymph-node dissection did not provide a statistically significant prolonged survival. Results remained consistent after propensity score matching. Multivariate analysis revealed poor performance status and bladder neck tumors as independent risk factors for NUTRFS. Lymph-node dissection was not a significant prognostic factor in preoperatively diagnosed NMIBC.

Conclusions: Routine lymph-node dissection may be unnecessary for all NMIBC cases; however, our findings suggest that this should be considered for NMIBC involving the bladder neck.