The Effect of Pelvic Lymph Node Dissection on Cancer-Specific Mortality in Partial Cystectomy According to Eligibility Criteria.
Academic Article
Overview
abstract
BACKGROUND: This study tested the rates of partial cystectomy (PC) according to PC eligibility criteria ( ≤ cT2 stage, tumor ≤ 3 cm, and segmental resection possible), as well as the effect of pelvic lymph node dissection (PLND) at PC on cancer-specific mortality (CSM). METHODS: In the Surveillance, Epidemiology, and End Results (SEER) database (2004-2021), the study identified PC patients according to eligibility criteria and PLND status. Kaplan-Meier (KM) and multivariable Cox regression models (CRMs) addressed CSM after inverse probability of treatment-weighting (IPTW) for age, sex, race, household income, and T stage. RESULTS: Of 2078 PC patients, only 492 (23.7%) fulfilled all three PC criteria. The remaining 1586 patients fulfilled only two (n = 858, 41.3%), one (n = 614, 29.5%), or none (n = 114, 5.5%) of the three criteria. Overall, 790 (49.8%) patients underwent PLND, with PLND performed for 191 (38.8%) patients who fulfilled all three criteria versus 395 (46.0%) who fulfilled two versus 322 (52.4%) who fulfilled one versus 73 (64.0%) who fulfilled no criteria. After IPTW adjustment addressing all 2078 PC patients, 5 year CSM rates were 69.7% with PLND versus 64.2% without PLND (multivariable hazard ratio [mHR], 0.65; 95% confidence interval [CI], 0.54-0.77; p < 0.001). Conversely, for the 492 patients who fulfilled all three PC criteria, the 5 year CSM rates were 83.2% versus 81.8% (mHR, 0.76; 95% CI, 0.46-1.26, p = 0.3). Finally, for the 1586 patients who did not fulfill all three criteria, the 5 year CSM rates were 66.6% versus 58.0% (mHR, 0.69; 95% CI, 0.57-0.84; p < 0.001). CONCLUSION: Only a small minority of PC patients met all three eligibility criteria, exhibiting the most favorable survival. For those individuals, PLND had no effect on CSM. Conversely, for the majority of PC patients who did not fulfill all three criteria, PLND independently predicted significantly lower CSM.
