Huang Shiwang, Jia Kaipeng, Cui Jingmin, Duan Jianfei, Li Xiaosong, Chai Wang, Shen Chong, Zhang Zhe, Chen Huitong, Liang Shan, Han Jingwen, Guo Jianing, Wu Zhouliang, Qie Yunkai, Hu Hailong
Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China.
Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China.
Sci Rep. 2025 May 29;15(1):18905. doi: 10.1038/s41598-025-03916-6.
This multicenter, retrospective study evaluated the impact of pelvic lymph node dissection (PLND) on survival outcomes in non-muscle invasive bladder cancer (NMIBC) patients undergoing radical cystectomy (RC) and identified factors associated with upstaging. A total of 544 NMIBC patients who underwent RC with or without PLND between 2019 and 2024 were analyzed. Survival outcomes, including cancer-specific survival (CSS) and recurrence-free survival (RFS), were compared using Kaplan-Meier analysis and Cox proportional hazards models, while factors associated with upstaging were examined through logistic regression. Of the 544 patients, 509 (93.6%) were staged as cT1, and 412 (75.7%) underwent PLND. Upstaging occurred in 193 patients (35.5%), with pathological stages distributed as pT1 (50.0%), pT2 (20.8%), pT3 (11.2%), and pT4 (3.5%). Among patients who underwent PLND, 29 (7.0%) had positive lymph nodes. PLND was associated with improved RFS (5-year: 84.3% vs. 71.5%; adjusted hazard ratio [HR] = 0.33, 95% confidence interval [CI]: 0.20-0.56, p < 0.001) but did not significantly impact CSS (5-year: 86.5% vs. 81.6%; adjusted HR = 0.57, 95% CI: 0.32-1.02, p = 0.06). Lymph node positivity was linked to the worst prognosis. cT1 tumors, histological subtypes, and PLND were significant predictors of upstaging. In patients with cT1 tumors or histological subtypes, repeat transurethral resection is recommended to obtain more precise staging, which may inform further therapeutic decisions. While PLND is not routinely recommended for all NMIBC patients, it may be considered in those with high-risk features, particularly cT1 tumors or histological subtypes.
这项多中心回顾性研究评估了盆腔淋巴结清扫术（PLND）对接受根治性膀胱切除术（RC）的非肌层浸润性膀胱癌（NMIBC）患者生存结局的影响，并确定了与分期上调相关的因素。对2019年至2024年间共544例行或未行PLND的NMIBC患者进行了分析。使用Kaplan-Meier分析和Cox比例风险模型比较了生存结局，包括癌症特异性生存（CSS）和无复发生存（RFS），同时通过逻辑回归分析与分期上调相关的因素。544例患者中，509例（93.6%）分期为cT1，412例（75.7%）接受了PLND。193例患者（35.5%）出现分期上调，病理分期分布为pT1（50.0%）、pT2（20.8%）、pT3（11.2%）和pT4（3.5%）。在接受PLND的患者中，29例（7.0%）淋巴结阳性。PLND与改善RFS相关（5年：84.3%对71.5%；调整后风险比[HR]=0.33，95%置信区间[CI]：0.20-0.56，p<0.001），但对CSS无显著影响（5年：86.5%对81.6%；调整后HR=0.57，95%CI：0.32-1.02，p=0.06）。淋巴结阳性与最差的预后相关。cT1肿瘤、组织学亚型和PLND是分期上调的重要预测因素。对于cT1肿瘤或组织学亚型的患者，建议重复经尿道切除术以获得更精确的分期，这可能为进一步的治疗决策提供依据。虽然并非所有NMIBC患者都常规推荐PLND，但对于具有高危特征的患者，尤其是cT1肿瘤或组织学亚型的患者，可以考虑进行PLND。
