ASCO: Extended Lymph Node Removal Not Beneficial for Bladder Cancer

No benefit in terms of disease-free or overall survival seen for those with muscle-invasive bladder cancer undergoing radical cystectomy

For patients with localized muscle-invasive bladder cancer undergoing radical cystectomy, extended lymphadenectomy (LND) is not associated with improved disease-free or overall survival, according to a study presented at the annual meeting of the American Society of Clinical Oncology, held from June 2 to 6 in Chicago.

Seth P. Lerner, M.D., from the Baylor College of Medicine in Houston, and colleagues compared ELND with standard LND (SLND) among patients with localized muscle-invasive bladder cancer undergoing radical cystectomy. After intraoperative exploration determined that patients did not have disease outside the pelvis, patients received standard bilateral pelvic LND, including external and internal iliac and obturator lymph nodes; those randomly assigned to the experimental arm underwent additional ELND up to at least the aortic bifurcation, including common iliac, presciatic, and presacral nodes. Overall, 618 eligible patients were randomly assigned to ELND or SLND (292 and 300, respectively). Both groups were followed for a median of 6.1 years.

The researchers found that the median number of lymph nodes removed was higher in the ELND versus SLND arm (41 versus 25), but no difference was seen in node metastasis (26 versus 24 percent). More patients undergoing ELND had N2 or N3 disease. Compared to SLND, ELND was associated with an increase in grade 3 to 4 adverse events (16 versus 8 percent). Deaths within 90 days of radical cystectomy occurred in 4.4 percent of patients (16 in ELND arm and nine in SLND arm). There was no significant difference observed between the groups in disease-free or overall survival.

“Extended lymphadenectomy is considered a standard of care and is increasingly used,” Lerner said in a statement, “especially for patients with locally advanced bladder cancer, who have a higher risk of lymph node metastases.”

Several authors disclosed ties to the biopharmaceutical and medical technology industries.

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