Pd30-04 Unveiling the Necessity: Should (Very) High-Risk Nmibc Patients Undergoing Rc Opt for Pelvic Lymph Node Dissection?—a Prospective Cohort Study

You have accessJournal of UrologyBladder Cancer: Non-invasive II (PD30)1 May 2024PD30-04 UNVEILING THE NECESSITY: SHOULD (VERY) HIGH-RISK NMIBC PATIENTS UNDERGOING RC OPT FOR PELVIC LYMPH NODE DISSECTION?—A PROSPECTIVE COHORT STUDY Qiang Lyu, Xiao Yang, Qiang Cao, and Juntao Zhuang Qiang LyuQiang Lyu , Xiao YangXiao Yang , Qiang CaoQiang Cao , and Juntao ZhuangJuntao Zhuang View All Author Informationhttps://doi.org/10.1097/01.JU.0001008848.77629.6f.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While Radical Cystectomy (RC) accompanied by Pelvic Lymph Node Dissection (PLND) stands as the cornerstone treatment for Muscle-Invasive Bladder Cancer (MIBC), its necessity remains a subject of contemplation for (very) high-risk Non-Muscle Invasive Bladder Cancer (NMIBC) due to the possible operative complications. This study was aimed to elucidate the necessity of PLND during RC for patients within the (very) high-risk NMIBC. METHODS: From January 2021, patients diagnosed with (very) high-risk NMIBC, displaying no signs of swollen lymph nodes (or lymph nodes ≤8mm) as per MRI/CT scans, were prospectively enrolled. The patients were then randomized to undergo either RC with PLND or RC only (NCT: 05123625). Comprehensive perioperative clinical data, 90-day postoperative complications, and related medical expenses were documented. The endpoint was progression-free survival (PFS) and overall survival (OS). RESULTS: From September 20, 2023, 101 patients were prospectivelly enrolled, though 6 cases were subsequently excluded due to muscle invasiveness. The cohort consisted of 81 males and 41 females. Within the RC+PLND group (40 cases), the median age was 66.5 years (IQR: 57-73), encompassing 17 high-risk and 23 very high-risk cases. The pathological evaluations revealed 37 high-grade and 3 low-grade cases, with stage distribution being Ta/Tis in 6 cases and T1 in 34 cases. An average of 14 lymph nodes were dissected, yet none tested positive. In the RC only group (55 cases), the median age was 66 years (IQR: 59-73), dividing into 36 high-risk and 19 very-high risk cases. Pathologically, there were 51 high-grade and 4 low-grade cases, with Ta/Tis in 9 cases and T1 in 46 cases. Operation time (253±65 min vs. 297±81 min, p=0.004) and intraoperative blood loss (244±165 ml vs. 303±220 ml, p=0.142) were significantly lower in the RC group compared to the RC+PLND group. Additionally, the postoperative hospital stay was shorter (7.7±2.5 days vs. 10.2±5.7 days, p=0.016), and the incidence of Clavien-Dindo grade III complications was lower (6.7% vs. 41.7%, p=0.06) in the RC group. Besides, at a median follow-up of 13.5 months (IQR: 4.4-20.4), no significant difference was observed in PFS and OS between the two groups. CONCLUSIONS: For (very) high-risk NMIBC patients, combined PLND has no survival benefit but increases the incidence of complications. Source of Funding: This study has received funding by the National Natural Science Foundation of China. (No: 82072832, 82273152) © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e625 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Qiang Lyu More articles by this author Xiao Yang More articles by this author Qiang Cao More articles by this author Juntao Zhuang More articles by this author Expand All Advertisement PDF downloadLoading ...