Pd38-12 National Performance of Lymphadenectomy for Muscle-Invasive Urothelial Cancer and an Exploratory Analysis to Define Optimal Lymph Node Yield Based on Southwest Oncology Group S1011 Trial

You have accessJournal of UrologyBladder Cancer: Invasive IV (PD38)1 May 2024PD38-12 NATIONAL PERFORMANCE OF LYMPHADENECTOMY FOR MUSCLE-INVASIVE UROTHELIAL CANCER AND AN EXPLORATORY ANALYSIS TO DEFINE OPTIMAL LYMPH NODE YIELD BASED ON SOUTHWEST ONCOLOGY GROUP S1011 TRIAL Leilei Xia, Daniel S. Roberson, Erika L. Wood, Anosh Dadabhoy, Everett Knudsen, Sofia Romano, Thomas J. Guzzo, Trinity J. Bivalacqua, and Siamak Daneshmand Leilei XiaLeilei Xia , Daniel S. RobersonDaniel S. Roberson , Erika L. WoodErika L. Wood , Anosh DadabhoyAnosh Dadabhoy , Everett KnudsenEverett Knudsen , Sofia RomanoSofia Romano , Thomas J. GuzzoThomas J. Guzzo , Trinity J. BivalacquaTrinity J. Bivalacqua , and Siamak DaneshmandSiamak Daneshmand View All Author Informationhttps://doi.org/10.1097/01.JU.0001009424.64728.0c.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: S1011 trial showed extended lymphadenectomy (ELND) provided no benefits compared to standard LND (SLND) in patients with muscle-invasive bladder cancer (MIBC) undergoing radical cystectomy (RC). Median lymph node yield (LNY) in S1011 SLND arm was 24 (range 6-61), which was significantly higher than previous studies. The high LNY can be attributed to high-quality LND, expert credentialed surgeons performing the RC, and pathology reviews performed by experienced pathologists. We hypothesized the national performance of LNY is unlikely to match the results of the trial. METHODS: We identified patients with cT2-4aN0-2 urothelial cancer who underwent open RC and LND with or without neoadjuvant chemotherapy (NAC) (same eligibility as S1011) from the National Cancer Database (NCDB) (2010-2019). We only included patients with a LNY of 6 to 61, mirroring SLND arm of S1011. We further performed an exploratory analysis to define optimal LNY by adjusting the lower range of LNY to match the median LNY in the S1011. RESULTS: A total of 6083 patients from 690 hospitals were included. LNY distribution is shown in Figure 1. Median LNY was 15, which was 9 nodes less than the S1011 SLND arm. To match the median LNY of 24 in S1011, the lower range for NCDB cohort had to be adjusted to 17 nodes, thus defining optimal LNY as LNY≥17. A total of 2757 patients (45.3%) had optimal LNY, and 404 hospitals (58.6%) had at least one patient with optimal LNY. No significant difference in LN+ between NCDB optimal LNY cohort and S1011 SLND arm (27% vs 24%, p=0.27, Table 1), suggesting the potential adequacy of using LNY≥17 for staging. Multivariable logistic regression showed higher hospital RC volume, more recent years of diagnosis and NAC (odds ratio OR=1.22, p=0.001) were associated with higher odds of achieving optimal LNY. CONCLUSIONS: Real-world data indicates that the national performance of LND for MIBC in the US, as evaluated by LNY, does not meet the standards set by the S1011 trial. This suggests a significant opportunity for improvement in real-world practice. Although not perfect, establishing an optimal LNY for LND could potentially enhance the quality of LND nationally. Further studies are required to rigorously define what constitutes an optimal LNY. Download PPT Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e811 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Leilei Xia More articles by this author Daniel S. Roberson More articles by this author Erika L. Wood More articles by this author Anosh Dadabhoy More articles by this author Everett Knudsen More articles by this author Sofia Romano More articles by this author Thomas J. Guzzo More articles by this author Trinity J. Bivalacqua More articles by this author Siamak Daneshmand More articles by this author Expand All Advertisement PDF downloadLoading ...