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Background <p>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). </p> Methods <p>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. </p> Results <p>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 &lt; 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.</p> Conclusions <p>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.</p>

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

  • 期刊论文

  • 发表日期：

    2025年5月10日

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  • Tomokazu Sazuka,
  • Rikiya Taoka,
  • Jun Miki,
  • Ryoichi Saito,
  • Wataru Fukuokaya,
  • Yoshiyuki Matsui,
  • Shingo Hatakeyama,
  • Takashi Kawahara,
  • Ayumu Matsuda,
  • Taketo Kawai,
  • Minoru Kato,
  • Takeshi Sano,
  • Fumihiko Urabe,
  • Soki Kashima,
  • Hirohito Naito,
  • Yoji Murakami,
  • Makito Miyake,
  • Kei Daizumoto,
  • Yuto Matsushita,
  • Takuji Hayashi,
  • Junichi Inokuchi,
  • Yusuke Sugino,
  • Kenichiro Shiga,
  • Noriya Yamaguchi,
  • Shingo Yamamoto,
  • Keiji Yasue,
  • Takashige Abe,
  • Shotaro Nakanishi,
  • Katsuyoshi Hashine,
  • Atsuro Sawada,
  • Kiyoaki Nishihara,
  • Hiroaki Matsumoto,
  • Shuichi Tatarano,
  • Koichiro Wada,
  • Sho Sekito,
  • Ryo Maruyama,
  • Naotaka Nishiyama,
  • Hiroyuki Nishiyama,
  • Hiroshi Kitamura,
  • Tomohiko Ichikawa

摘要

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.