title: The role of pelvic lymphadenectomy in non-muscle invasive bladder cancer.
abstract: BACKGROUND
  We evaluated whether the extent of lymphadenectomy at the time of radical cystectomy for non-muscle invasive bladder cancer (NMIBC) impacts recurrence free survival.
  
  
  METHODS
  We conducted an IRB approved retrospective analysis of patients with clinical NMIBC who underwent radical cystectomy from 1990-2010. Patients were stratified based on extent of lymph node dissection using total lymph node yield as a surrogate indicator of lymph node dissection extent, with cut off analyses performed at 0, 8, 10, and 20 nodes removed. Analyses of recurrence free survival (RFS) were performed using log-rank analysis and multivariate Cox regression.
  
  
  RESULTS
  One hundred and ninety-six patients with NMIBC met the inclusion criteria for this study, with no differences in RFS detected in those who had ≥ 10 nodes compared to < 10 nodes removed (p = 0.63). Upon multivariate analysis, ≥ 10 nodes removed (HR 1.00; p = 0.99) was not significantly associated with decreased RFS, while high grade tumor (HR 3.22; p = 0.05) and positive margin status (HR 3.87; p = 0.04) were. The median number of nodes removed was 8 (range 0-45), with no difference in RFS using this as a cut off point (p = 0.19). The removal of ≥ 20 nodes did not predict worse survival compared to < 20 nodes removed (p = 0.07).
  
  
  CONCLUSIONS
  Although the extent of lymphadenectomy has been associated with improved survival in patients undergoing radical cystectomy for muscle invasive bladder cancer, we were unable to detect an impact of lymph node dissection extent on RFS in patients with NMIBC. This finding emphasizes that when determining extent of lymph node dissection in radical cystectomy, one size does not fit all.
authors: Columbia University College of Physicians and Surgeons, New York, New York, USA.
authors: James
authors: J
authors: Lin
authors: Christopher M
authors: CM
authors: Deibert
authors: Dara
authors: D
authors: Holder
authors: Mitchell C
authors: MC
authors: Benson
authors: James M
authors: JM
authors: McKiernan
mesh_terms: D000368:Aged; D017024:Chemotherapy, Adjuvant; D015653:Cystectomy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D009130:Muscle, Smooth / Q000473:pathology; D020360:Neoadjuvant Therapy; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D010388:Pelvis; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*