Impact of pelvic lymph node dissection on survival outcomes in non-muscle invasive bladder cancer: A multicenter retrospective study.

Abstract

e16594 Background: Pelvic lymph node dissection (PLND) is a standard component of radical cystectomy (RC) in patients with muscle-invasive bladder cancer (MIBC), where it has been shown to improve survival outcomes. However, the role of PLND in non-muscle invasive bladder cancer (NMIBC) patients undergoing RC remains unclear. While radical cystectomy is a treatment option for high-risk NMIBC patients, it is uncertain whether PLND can improve survival in this cohort or influence the rate of upstaging. This study aims to evaluate the impact of PLND on survival outcomes in NMIBC patients undergoing RC and identify factors associated with upstaging. Methods: A multicenter, retrospective analysis was conducted on 544 NMIBC patients who underwent RC with or without PLND between 2019 and 2024. The primary endpoint was cancer-specific survival (CSS), and secondary endpoints included recurrence-free survival (RFS), upstaging rate, and associated factors. Kaplan-Meier survival analysis and Cox regression models were used to compare survival outcomes between the PLND and no-PLND groups. Results: Of 544 patients, 509 (93.6%) were staged as cT1, and 412 (75.7%) underwent PLND. Upstaging occurred in 193 patients (35.5%), with pathological T-stages as follows: pT1 in 50.0%, pT2 in 20.8%, pT3 in 11.2%, and pT4 in 3.5%. Seven percent of the PLND group had positive lymph nodes. PLND was associated with significantly improved RFS (5-year: 84.3% vs. 71.5%, p < 0.05) but did not impact CSS (5-year: 86.5% vs. 81.6%, p = 0.12). Lymph node negativity (pN0) was associated with the best survival outcomes, while lymph node positivity (pN+) was linked to the worst outcomes. cT1 stage, the presence of histological subtypes, and PLND were significantly associated with upstaging (p < 0.05). Conclusions: PLND during RC significantly improves RFS in NMIBC patients but does not affect CSS. Lymph node positivity remains a crucial prognostic factor, and patients with cT1 stage or histological subtypes may benefit from repeat transurethral resection (TUR) to reduce understaging risk.