Prognostic Value of the Extent of Lymphadenectomy for Overall Survival Among Patients with Non-muscle Invasive Bladder Cancer, A Retrospective Cohort Study

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BACKGROUND: The purpose of this study was to find out the impact of lymph node dissection (LND) on the prognosis of patients undergoing cystectomy for non-muscle invasive bladder cancer (NMIBC) and determine the minimum number of lymph nodes (LNs) for resection. PATIENTS AND METHODS: Patients with NMIBC undergoing cystectomy between 2004 and 2015 were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching and multivariate Cox regression analyses were performed to mitigate the influence of selection bias and control for potential confounding variables. RESULTS: Of 1950 patients with NMIBC, 1353 underwent LND, of which 58 (4.2%) exhibited positive LNs. LND were associated with better prognosis in the whole cohort (P < 0.001). Patients who had positive lymph nodes were found to have the worst prognosis (P < 0.001). Restricted cubic spline (RCS) found that patients with at least 8 LNs examined show longer survival than those with nLNE < 8, which was further validated in multivariable Cox regression [HR 0.66 (0.59, 0.76)]. Subgroup analysis indicated that nLNE ≥ 8 was associated with significantly improved overall survival in T1 and Tis patients both before and after PSM, while for Ta patients, the impact of LND or nLNE ≥ 8 on prognosis was insignificant. Additionally, for patients with negative lymph node, nLNE ≥ 8 still resulted in better prognosis [HR 0.73 (0.61, 0.87)]. Furthermore, sensitivity analyses replicated the same results in patients more than 80 years old and found that patients with nLNE ≥ 8 demonstrated superior prognosis than those with less than 8 lymph nodes retrieved. CONCLUSIONS: Among patients with NMIBC, it is crucial to remove eight or more lymph node effectively during cystectomy, except in Ta subgroup.

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