Extended lymphadenectomy does not improve disease-free, overall survival and is linked to more adverse events
By Elana Gotkine HealthDay Reporter
THURSDAY, Oct. 3, 2024 (HealthDay News) — For patients with muscle-invasive bladder cancer, extended lymphadenectomy does not improve disease-free or overall survival compared with standard lymphadenectomy, according to a study published in the Oct. 3 issue of the New England Journal of Medicine.
Seth P. Lerner, M.D., from the Baylor College of Medicine in Houston, and colleagues randomly assigned 592 eligible patients with localized muscle-invasive bladder cancer of clinical stage T2 to T4a with two or fewer positive nodes to undergo extended lymphadenectomy, including removal of common iliac, presciatic, and presacral nodes, or bilateral standard lymphadenectomy (292 and 300 patients, respectively).
Overall, 57 percent of the patients had received neoadjuvant chemotherapy. The researchers found that at a median follow-up of 6.1 years, recurrence or death had occurred in 45 and 42 percent of patients in the extended- and standard-lymphadenectomy groups, respectively, and the estimated five-year disease-free survival rates were 56 and 60 percent, respectively (hazard ratio, 1.10; 95 percent confidence interval, 0.86 to 1.40; P = 0.45). At five years, overall survival was 59 and 63 percent in the extended- and standard-lymphadenectomy groups, respectively (hazard ratio, 1.13; 95 percent confidence interval, 0.88 to 1.45). Adverse events of grade 3 to 5 occurred in 54 and 44 percent of patients in the extended- and standard-lymphadenectomy groups, respectively; death within 90 days after surgery occurred in 7 and 2 percent, respectively.
“We found that extended lymphadenectomy did not improve disease-free survival or overall survival as compared with standard lymphadenectomy among patients with localized muscle-invasive bladder cancer undergoing radical cystectomy,” the authors write.
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