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The following is a summary of “Pelvic lymphadenectomy: Evaluating nodal stage migration and will rogers effect in bladder cancer,” published in the January 2024  issue of Urology by Sodagum, et al.

Together, pelvic lymphadenectomy (PLND) and radical cystectomy (RC) are very helpful for diagnosing and treating people with bladder cancer. Even though preoperative treatment and prospective data are back to standard PLND, there is still debate about the best PLND length and which patients should get it. About 40% of patients might not get enough PLND, even though 25% have positive lymph nodes (LN) at the time of RC. They thought that PLND would still be important in treating bladder cancer. For a study, researchers sought to understand better how crucial nodal yield is for predicting outcomes; they looked back at a group of patients who had RC. They found pTanyNx/0M0 bladder cancer patients who had RC from 2004 to 2015 using the Surveillance, Epidemiology, and End Results (SEER) program. Kaplan-Meier plots and Cox proportional hazards models were used to look at mortality rates for people with cancer. PLND was used as the main covariate to look at the patients. The survival study then divided the patients undergoing PLND into groups based on their T stage, LN yield (ϲ<10, 11–20, 21–30, and >30), and LN yield as a continuous variable.

The last group was made up of pTanyNx/0M0 patients with urothelial bladder cancer (n = 12,096). The average time between follow-ups was 39 months (IQR: 17–77 months). A median LN yield 14 was seen in 81.45% of patients with PLND (IQR: 7–23). Most of the time, patients (44.68%) had T2 cancer. When age and T stage were considered, patients who got PLND had better CSS (HR = 0.56; 95% CI: 0.51–0.62]) than patients who did not get PLND. When patients were grouped by LN yield, survival went up in a way that was “dose-dependent” (>30 LN: HR = 0.76, 95% CI: 0.66–0.87). When they separated patients into those with non–muscle-invasive (NMIBC) and muscle-invasive (MIBC) bladder cancer, They saw similar results.

In a large modern group of pTanyNx/0M0 bladder cancer patients, They discovered that PLND had a big effect on the cancer. Higher LN output was linked to better CSS in both non-muscle-invasive and muscle-invasive diseases. Their results support the idea of hidden micrometastasis, even in diseases that don’t invade muscles. Also, because of new developments in adjuvant immunotherapy, The results showed how important it is to have enough nodes for correct grading and the best treatment.

Source: sciencedirect.com/science/article/abs/pii/S1078143923003241