Ślusarczyk Aleksander, Scilipoti Pietro, Marcq Gautier, Pradere Benjamin, Contieri Roberto, Krajewski Wojciech, Laukthina Ekaterina, Del Giudice Francesco, Longoni Mattia, Gallioli Andrea, Abu-Ghanem Yasmin, Khan Muhammed Shamin, Soria Francesco, Albisinni Simone, Rouprêt Morgan, Radziszewski Piotr, Montorsi Francesco, Briganti Alberto, Moschini Marco
Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland.
Department of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Via Olgettina, 60, 20132, Milan, Italy.
World J Urol. 2025 Mar 20;43(1):181. doi: 10.1007/s00345-025-05549-w.
Lymph node dissection (LND) is an essential part of radical cystectomy (RC) performed with curative intent for invasive urothelial bladder cancer (UBC). This meta-analysis synthesizes evidence from randomized controlled trials (RCTs) comparing outcomes of extended and standard LND during RC.
Systematic searches of PubMed, Scopus, and Web of Science, conducted on November 10, 2024, identified RCTs that compared outcomes of standard (removal of pelvic lymph nodes [LNs]) versus extended LND (removal of pelvic and retroperitoneal LNs) during RC. Intention-to-treat populations were analyzed. Primary outcomes were recurrence-free (RFS) and overall survival (OS).
Two RCTs involved 993 patients, among whom 490 were randomized to extended and 503 to standard LND. We did not find evidence that RFS (hazard ratio [HR] 1.01, 95% confidence interval [CI] 0.83-1.24) and OS (HR 0.98, 95% CI 0.81-1.19) differed between patients undergoing extended and standard LND. The risk of local recurrence did not differ between extended and standard LND (relative risk [RR] 1.17, 95% CI 0.80-1.72). The risk of major complications (grade > 3) was higher for the extended template (RR 1.22, 95% CI 1.05-1.41), as was the 90-day postoperative mortality (RR 1.93, 95% CI 1.01-3.69). The limited number of studies and sample size constitute major limitations.
This meta-analysis demonstrates that extended LND was not associated with improved RFS or OS compared to standard LND, but was linked to increased morbidity. Therefore, pelvic lymphadenectomy up to the common iliac bifurcation should remain the standard of care during RC.
淋巴结清扫术（LND）是根治性膀胱切除术（RC）的重要组成部分，用于浸润性尿路上皮膀胱癌（UBC）的根治性治疗。本荟萃分析综合了来自随机对照试验（RCT）的证据，比较了RC期间扩大淋巴结清扫术和标准淋巴结清扫术的结果。
于2024年11月10日对PubMed、Scopus和Web of Science进行系统检索，确定了比较RC期间标准（盆腔淋巴结[LNs]切除）与扩大淋巴结清扫术（盆腔和腹膜后淋巴结切除）结果的RCT。对意向性治疗人群进行分析。主要结局为无复发生存期（RFS）和总生存期（OS）。
两项RCT涉及993例患者，其中490例随机分配至扩大淋巴结清扫组，503例随机分配至标准淋巴结清扫组。我们没有发现证据表明接受扩大淋巴结清扫术和标准淋巴结清扫术的患者在RFS（风险比[HR]1.01，95%置信区间[CI]0.83-1.24）和OS（HR 0.98，95%CI 0.81-1.19）方面存在差异。扩大淋巴结清扫术和标准淋巴结清扫术之间的局部复发风险没有差异（相对风险[RR]1.17，95%CI 0.80-1.72）。扩大模板组的主要并发症（3级以上）风险更高（RR 1.22，95%CI 1.05-1.41），术后90天死亡率也是如此（RR 1.93，95%CI 1.01-3.69）。研究数量有限和样本量构成主要局限性。
本荟萃分析表明，与标准淋巴结清扫术相比，扩大淋巴结清扫术与改善RFS或OS无关，但与发病率增加有关。因此，在RC期间，至髂总动脉分叉处的盆腔淋巴结清扫术应仍然是治疗标准。
