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Background <p>Radical cystectomy (RC) with neoadjuvant chemotherapy (NAC) and pelvic lymph node dissection (PLND) is standard for muscle-invasive bladder cancer (MIBC). While PLND improves staging and local control, the optimal extent is debated. This study used the SEER database (2000–2021) to evaluate lymph node yield's (LNY) prognostic significance.</p> Methods <p>We included 12,698 patients who underwent PLND, stratified by LNY quartiles (cutoffs at 12, 19, and 29). Inverse probability of treatment weighting (IPTW) was applied to balance baseline characteristics. Cox regression, Kaplan–Meier curves, and competing risk models assessed the impact of LNY on overall survival (OS) and cancer-specific survival (CSS). A prognostic nomogram incorporating LNY was developed and validated using LASSO regression, the area under the curve (AUC) and calibration plots.</p> Results <p>The optimal threshold for LNY was determined to be 12, with LNY ≥ 12 associated with a 17% reduction in all-cause mortality risk (HR 0.83, 95% CI 0.79–0.88). An increase in LNY was correlated with improvements in OS and CSS, with the 5-year OS rate increasing from 46.0% to 55.6%. A nonlinear relationship between LNY and all-cause mortality risk was observed, as the protective effect diminished after exceeding 39.</p> Conclusions <p>This study supports the establishment of LNY threshold of 12 as an indicator of surgical completeness; an LNY of 20–39 may be associated with a sustained protective effect. However, excessive LNY may not yield additional benefits. Clinical decision-making should consider patient characteristics and healthcare accessibility to optimize outcomes for bladder cancer.</p>

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Prognostic significance of lymph node yield in pelvic lymph node dissection for bladder cancer: population-based study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月29日

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  • Wei He,
  • Ziwei Wang,
  • Maoyu Wang,
  • Qing Chen,
  • Chen Zhang,
  • Yue Wang,
  • Xufeng Yu,
  • Yi Wang,
  • Hui Zhang,
  • Jiaxin Xie,
  • Xuncheng Yang,
  • Zhensheng Zhang,
  • Chuanliang Xu,
  • Shuxiong Zeng

摘要

Background

Radical cystectomy (RC) with neoadjuvant chemotherapy (NAC) and pelvic lymph node dissection (PLND) is standard for muscle-invasive bladder cancer (MIBC). While PLND improves staging and local control, the optimal extent is debated. This study used the SEER database (2000–2021) to evaluate lymph node yield's (LNY) prognostic significance.

Methods

We included 12,698 patients who underwent PLND, stratified by LNY quartiles (cutoffs at 12, 19, and 29). Inverse probability of treatment weighting (IPTW) was applied to balance baseline characteristics. Cox regression, Kaplan–Meier curves, and competing risk models assessed the impact of LNY on overall survival (OS) and cancer-specific survival (CSS). A prognostic nomogram incorporating LNY was developed and validated using LASSO regression, the area under the curve (AUC) and calibration plots.

Results

The optimal threshold for LNY was determined to be 12, with LNY ≥ 12 associated with a 17% reduction in all-cause mortality risk (HR 0.83, 95% CI 0.79–0.88). An increase in LNY was correlated with improvements in OS and CSS, with the 5-year OS rate increasing from 46.0% to 55.6%. A nonlinear relationship between LNY and all-cause mortality risk was observed, as the protective effect diminished after exceeding 39.

Conclusions

This study supports the establishment of LNY threshold of 12 as an indicator of surgical completeness; an LNY of 20–39 may be associated with a sustained protective effect. However, excessive LNY may not yield additional benefits. Clinical decision-making should consider patient characteristics and healthcare accessibility to optimize outcomes for bladder cancer.