Standard Versus Extended Pelvic Lymphadenectomy in Patients With Bladder Cancer: A Systematic Review and Meta-analysis.

IF 1.6 4区医学 Q4 ONCOLOGY

American Journal of Clinical Oncology-Cancer Clinical Trials Pub Date : 2025-04-21 DOI:10.1097/COC.0000000000001206

Hunaina Aman, Muhammad Hamza, Asad Ramzan, Mariam Saqib, Zain Ul Abideen, Abdul Haseeb, Hira Habib, Aiza Bint-E-Shafqat, Abdul Azeez Umar Azad, Hira Waris, Mushood Ahmed, Muhammad Ayyan, Nouman Aziz

{"title":"Standard Versus Extended Pelvic Lymphadenectomy in Patients With Bladder Cancer: A Systematic Review and Meta-analysis.","authors":"Hunaina Aman, Muhammad Hamza, Asad Ramzan, Mariam Saqib, Zain Ul Abideen, Abdul Haseeb, Hira Habib, Aiza Bint-E-Shafqat, Abdul Azeez Umar Azad, Hira Waris, Mushood Ahmed, Muhammad Ayyan, Nouman Aziz","doi":"10.1097/COC.0000000000001206","DOIUrl":null,"url":null,"abstract":"Objectives: For decades, pelvic lymph node dissection (PLND) has been a critical component of radical cystectomy in patients with bladder cancer. Although its role in curative surgery for high-risk non-muscle-invasive and muscle-invasive cases is well-established, the therapeutic advantages of extended PLND remain a topic of ongoing debate.Methods: A comprehensive literature search of major bibliographic databases was performed from inception to November 2024. Studies comparing extended PLND (extended or super extended) with standard PLND were identified. Data for clinical outcomes was extracted and pooled estimates were calculated using a random effects model with RevMan 5.4.Results: A total of 11 studies (2 RCTs and 9 observational) were included reporting data for 4001 patients. The pooled analysis demonstrated that extended PLND was associated with significantly better recurrence-free survival (HR=0.67, 95% CI: 0.60-0.74). Standard PLND led to significantly higher 5-year recurrence rates (RR=1.44, 95% CI: 1.28-1.62) compared with the extended approach. The pooled estimates for disease-specific survival (HR=0.86, 95% CI: 0.62-1.19), overall survival (HR=0.99, 95% CI: 0.86-1.16), and complications remained comparable.Conclusions: Extended PLND can lead to favorable recurrence-free survival and 5-year recurrence rates. However, retrospective observational studies mainly drive the evidence, and additional RCTs are required to reach a definitive conclusion.","PeriodicalId":50812,"journal":{"name":"American Journal of Clinical Oncology-Cancer Clinical Trials","volume":" ","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Clinical Oncology-Cancer Clinical Trials","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/COC.0000000000001206","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"ONCOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Objectives: For decades, pelvic lymph node dissection (PLND) has been a critical component of radical cystectomy in patients with bladder cancer. Although its role in curative surgery for high-risk non-muscle-invasive and muscle-invasive cases is well-established, the therapeutic advantages of extended PLND remain a topic of ongoing debate.

Methods: A comprehensive literature search of major bibliographic databases was performed from inception to November 2024. Studies comparing extended PLND (extended or super extended) with standard PLND were identified. Data for clinical outcomes was extracted and pooled estimates were calculated using a random effects model with RevMan 5.4.

Results: A total of 11 studies (2 RCTs and 9 observational) were included reporting data for 4001 patients. The pooled analysis demonstrated that extended PLND was associated with significantly better recurrence-free survival (HR=0.67, 95% CI: 0.60-0.74). Standard PLND led to significantly higher 5-year recurrence rates (RR=1.44, 95% CI: 1.28-1.62) compared with the extended approach. The pooled estimates for disease-specific survival (HR=0.86, 95% CI: 0.62-1.19), overall survival (HR=0.99, 95% CI: 0.86-1.16), and complications remained comparable.

Conclusions: Extended PLND can lead to favorable recurrence-free survival and 5-year recurrence rates. However, retrospective observational studies mainly drive the evidence, and additional RCTs are required to reach a definitive conclusion.

查看原文本刊更多论文

标准与扩展盆腔淋巴结切除术在膀胱癌患者中的应用：一项系统回顾和荟萃分析。

目的：几十年来，盆腔淋巴结清扫术（PLND）一直是膀胱癌患者根治性膀胱切除术的关键组成部分。虽然它在高风险非肌创和肌创病例的治疗性手术中的作用是公认的，但扩展PLND的治疗优势仍然是一个持续争论的话题。方法：从建站至2024年11月对各大书目数据库进行综合文献检索。对扩展PLND（扩展或超扩展）与标准PLND进行了比较研究。提取临床结局数据，使用RevMan 5.4随机效应模型计算汇总估计。结果：共纳入11项研究（2项随机对照试验和9项观察性研究），报告了4001例患者的数据。合并分析表明，延长PLND与更好的无复发生存相关（HR=0.67, 95% CI: 0.60-0.74）。与扩展方法相比，标准PLND的5年复发率明显更高（RR=1.44, 95% CI: 1.28-1.62）。疾病特异性生存（HR=0.86, 95% CI: 0.62-1.19）、总生存（HR=0.99, 95% CI: 0.86-1.16）和并发症的汇总估计仍然具有可比性。结论：延长PLND可导致良好的无复发生存和5年复发率。然而，回顾性观察性研究主要推动证据，并需要额外的随机对照试验来得出明确的结论。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

American Journal of Clinical Oncology-Cancer Clinical Trials 医学-肿瘤学

CiteScore

4.90

自引率

0.00%

发文量

130

审稿时长

4-8 weeks

期刊介绍： American Journal of Clinical Oncology is a multidisciplinary journal for cancer surgeons, radiation oncologists, medical oncologists, GYN oncologists, and pediatric oncologists. The emphasis of AJCO is on combined modality multidisciplinary loco-regional management of cancer. The journal also gives emphasis to translational research, outcome studies, and cost utility analyses, and includes opinion pieces and review articles. The editorial board includes a large number of distinguished surgeons, radiation oncologists, medical oncologists, GYN oncologists, pediatric oncologists, and others who are internationally recognized for expertise in their fields.