Marmiroli Andrea, Longoni Mattia, Le Quynh Chi, Falkenbach Fabian, Nicolazzini Michele, Catanzaro Calogero, Polverino Federico, Goyal Jordan A, Luzzago Stefano, Mistretta Francesco Alessandro, Piccinelli Mattia, Saad Fred, Shariat Shahrokh F, Briganti Alberto, Chun Felix K H, Graefen Markus, Palumbo Carlotta, Schiavina Riccardo, Longo Nicola, Musi Gennaro, Karakiewicz Pierre I
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada.
Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy.
Ann Surg Oncol. 2025 Jul 23. doi: 10.1245/s10434-025-17841-5.
This study was designed to test the association between adverse in-hospital outcomes and pelvic lymph node dissection (PLND) at partial cystectomy (PC) for nonmetastatic bladder cancer (BCa).
We identified patients treated with PC for BCa (National Inpatient Sample 2012-2019). First, estimated annual percentage changes (EAPC) tested temporal trends of PLND at PC. Second, descriptive analyses, propensity score matching (PSM, ratio 1:2) and multivariable logistic regression models (LRMs) were used.
Of 1,289 BCa patients treated with PC, 201 (16.0%) underwent PLND. The rates of PLND at PC decreased from 24.8 to 5.4% over the study span (EAPC - 11.3%; p = 0.01). Pelvic lymph node dissection patients were younger (67 vs. 71 years old; p < 0.001), exhibited a lower number of comorbidities (Charlson Comorbidity Index [CCI] 0: 41% vs. 38%; p = 0.006), and were more frequently admitted to teaching (83% vs. 76%; p = 0.03) and large bedsize (69% vs. 57%; p = 0.004) hospitals. After PSM, 201 of 201 (100%) PLND vs. 402 of 1,088 (36.9%) no-PLND at PC patients were included in further analyses. Pelvic lymph node dissection at PC patients only exhibited significantly higher rate of intraoperative complications (9% vs. 3.7%; p = 0.008), but no statistically significant differences in 13 of 14 other categories were recorded (all p values > 0.09). In multivariable LRMs, PLND independently predicted 2.6-fold higher rate of intraoperative complications (p = 0.01).
The rate of PLND drastically decreased over time. PLND vs. no-PLND at PC only resulted in a moderate increase in intraoperative complications without differences in 13 other adverse in-hospital outcomes, which included complications, in-hospital mortality, length of stay, and total hospital charges.
本研究旨在测试非转移性膀胱癌（BCa）行部分膀胱切除术（PC）时，院内不良结局与盆腔淋巴结清扫术（PLND）之间的关联。
我们确定了接受PC治疗的BCa患者（2012 - 2019年国家住院患者样本）。首先，估计年度百分比变化（EAPC）测试PC时PLND的时间趋势。其次，使用描述性分析、倾向评分匹配（PSM，比例1:2）和多变量逻辑回归模型（LRM）。
在1289例接受PC治疗的BCa患者中，201例（16.0%）接受了PLND。在研究期间，PC时PLND的发生率从24.8%降至5.4%（EAPC - 11.3%；p = 0.01）。盆腔淋巴结清扫术患者更年轻（67岁对71岁；p < 0.001），合并症数量更少（Charlson合并症指数[CCI]为0：41%对38%；p = 0.006），更频繁地入住教学医院（83%对76%；p = 0.03）和大型床位医院（69%对57%；p = 0.004）。PSM后，201例接受PLND的患者中的201例（100%）与1088例未接受PLND的患者中的402例（36.9%）纳入进一步分析。PC患者行盆腔淋巴结清扫术仅术中并发症发生率显著更高（9%对3.7%；p = 0.008），但在其他14个类别中的13个类别中未记录到统计学显著差异（所有p值> 0.09）。在多变量LRM中，PLND独立预测术中并发症发生率高2.6倍（p = 0.01）。
随着时间的推移，PLND的发生率急剧下降。PC时PLND与未行PLND相比，仅导致术中并发症适度增加，而在包括并发症、院内死亡率、住院时间和总住院费用在内的其他13种院内不良结局方面无差异。
