Sazuka Tomokazu, Taoka Rikiya, Miki Jun, Saito Ryoichi, Fukuokaya Wataru, Matsui Yoshiyuki, Hatakeyama Shingo, Kawahara Takashi, Matsuda Ayumu, Kawai Taketo, Kato Minoru, Sano Takeshi, Urabe Fumihiko, Kashima Soki, Naito Hirohito, Murakami Yoji, Miyake Makito, Daizumoto Kei, Matsushita Yuto, Hayashi Takuji, Inokuchi Junichi, Sugino Yusuke, Shiga Kenichiro, Yamaguchi Noriya, Yamamoto Shingo, Yasue Keiji, Abe Takashige, Nakanishi Shotaro, Hashine Katsuyoshi, Sawada Atsuro, Nishihara Kiyoaki, Matsumoto Hiroaki, Tatarano Shuichi, Wada Koichiro, Sekito Sho, Maruyama Ryo, Nishiyama Naotaka, Nishiyama Hiroyuki, Kitamura Hiroshi, Ichikawa Tomohiko
Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan.
Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, Japan.
Int J Clin Oncol. 2025 May 10. doi: 10.1007/s10147-025-02778-2.
There is no definitive consensus on the necessity and impact of lymph-node dissection during radical cystectomy for non-muscle-invasive bladder cancer (NMIBC). This study aimed to evaluate the prognostic significance of lymph-node dissection in NMIBC and identify preoperative factors influencing non-urinary tract recurrence-free survival (NUTRFS).
We retrospectively analyzed data for 2674 cases of bladder cancer treated with radical cystectomy between January 2013 and December 2019 from a multicenter Japanese database; 410 patients were preoperatively diagnosed with NMIBC. Patients were divided into lymph-node dissection and non-lymph-node dissection groups, and NUTRFS and overall survival were compared as endpoints. Univariate and multivariate analyses were performed to determine NUTRFS prognostic factors.
Lymph-node dissection was performed in 374/410 patients and not in 36/410. Compared with the lymph-node dissection group, the non-lymph-node dissection group was older, and had a lower proportion of a performance status of 0 and a higher proportion of clinical stage < T1 disease. The pathological lymph-node positivity rate in the lymph-node dissection group was 6.9%. However, lymph-node dissection did not provide a statistically significant prolonged survival. Results remained consistent after propensity score matching. Multivariate analysis revealed poor performance status and bladder neck tumors as independent risk factors for NUTRFS. Lymph-node dissection was not a significant prognostic factor in preoperatively diagnosed NMIBC.
Routine lymph-node dissection may be unnecessary for all NMIBC cases; however, our findings suggest that this should be considered for NMIBC involving the bladder neck.
对于非肌层浸润性膀胱癌（NMIBC）根治性膀胱切除术中淋巴结清扫的必要性和影响，目前尚无明确共识。本研究旨在评估NMIBC中淋巴结清扫的预后意义，并确定影响无非尿路复发生存（NUTRFS）的术前因素。
我们回顾性分析了2013年1月至2019年12月间来自日本多中心数据库的2674例接受根治性膀胱切除术的膀胱癌患者的数据；410例患者术前诊断为NMIBC。患者分为淋巴结清扫组和非淋巴结清扫组，以NUTRFS和总生存作为终点进行比较。进行单因素和多因素分析以确定NUTRFS的预后因素。
410例患者中，374例行淋巴结清扫，36例未行。与淋巴结清扫组相比，非淋巴结清扫组患者年龄更大，体能状态为0的比例更低，临床分期＜T1期疾病的比例更高。淋巴结清扫组的病理淋巴结阳性率为6.9%。然而，淋巴结清扫并未在统计学上显著延长生存期。倾向评分匹配后结果仍一致。多因素分析显示体能状态差和膀胱颈部肿瘤是NUTRFS的独立危险因素。在术前诊断为NMIBC的患者中，淋巴结清扫不是显著的预后因素。
对于所有NMIBC病例，常规淋巴结清扫可能不必要；然而，我们的研究结果表明，对于累及膀胱颈部的NMIBC应考虑进行淋巴结清扫。
