Partial and radical cystectomy provides equivalent oncologic outcomes in bladder cancer when combined with adequate lymph node dissection: A population-based study,Urologic Oncology: Seminars and Original Investigations

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Partial and radical cystectomy provides equivalent oncologic outcomes in bladder cancer when combined with adequate lymph node dissection: A population-based study
Urologic Oncology: Seminars and Original Investigations ( IF 2.4 ) Pub Date : 2023-03-23 , DOI: 10.1016/j.urolonc.2023.02.004
Gongwei Long ₁ , Zhiquan Hu ₂ , Zheng Liu ₂ , Zhangqun Ye ₂ , Shaogang Wang ₂ , Dongwen Wang ₃ , Chunguang Yang ₂

Affiliation

Purpose

To compare the oncologic outcomes of bladder cancer (BCa) patients after partial cystectomy (PC) or radical cystectomy (RC) combined with lymph node dissection (LND).

Methods

Relevant data from BCa patients who had >3 lymph nodes (LNs) removed were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Different thresholds of LN count in LND were tested to eliminate potential selection bias, and the optimal threshold was applied to screen patients who underwent adequate LND. After propensity score matching, the oncologic outcomes after PC or RC were compared in patients who underwent adequate LND.

Results

After preliminary screening, 6,785 BCa cases diagnosed between 2004 and 2015 with removal of > 3 LNs were enrolled in the analysis, including 633 (9.3%) PC cases and 6,152 (90.7%) RC cases. The PC and RC groups presented entirely different profiles in clinical parameters such as sex, T stage, number of lymph nodes (LNs) removed, and adjuvant therapy. In particular, the LN-positive rate and count were higher in the RC group, even after adjusting for other confounding factors. After comparison using different thresholds, the LN positive rate and count were similar when the LN count in LND was restricted to > 12. In patients who had > 12 LNs removed, after propensity score matching, PC and RC presented similar oncologic outcomes. Further exploration found that the prognosis of patients was associated with age, T stage, and the number of positive LNs.

Conclusion

PC and RC could provide equivalent oncologic outcomes in BCa when combined with adequate LND. The conclusion needs further validation in future studies.

中文翻译：

膀胱部分切除术和根治性膀胱切除术与充分的淋巴结清扫相结合时，可以为膀胱癌提供同等的肿瘤学结果：一项基于人群的研究

目的

比较膀胱部分切除术（PC）或根治性膀胱切除术（RC）联合淋巴结清扫术（LND）后膀胱癌（BCa）患者的肿瘤学结果。

方法

从监测、流行病学和最终结果 (SEER) 数据库中检索了已切除 > 3 个淋巴结 (LN) 的 BCa 患者的相关数据。测试了 LND 中 LN 计数的不同阈值，以消除潜在的选择偏差，并应用最佳阈值来筛选接受充分 LND 的患者。倾向评分匹配后，对接受充分 LND 的患者进行 PC 或 RC 后的肿瘤学结果进行比较。

结果

经过初步筛选，2004年至2015年间诊断的6,785例切除>3个淋巴结的BCa病例纳入分析，其中PC病例633例（9.3%），RC病例6,152例（90.7%）。PC 组和 RC 组在性别、T 分期、切除的淋巴结 (LN) 数量和辅助治疗等临床参数方面表现出完全不同的特征。特别是，即使在调整其他混杂因素后，RC 组的 LN 阳性率和计数也较高。使用不同阈值进行比较后，当 LND 中的 LN 计数限制为 > 12 时，LN 阳性率和计数相似。在去除 > 12 个 LN 的患者中，倾向评分匹配后，PC 和 RC 呈现相似的肿瘤学结果。进一步探索发现，患者的预后与年龄、T分期、阳性淋巴结数量有关。