Extent of Pelvic Lymph Node Dissection at Partial Cystectomy: Effect on Cancer-Specific Mortality

Introduction: We assessed the extent of pelvic lymph node dissection (PLND) at partial cystectomy (PC) according to PC eligibility (≤cT2 stage, tumor ≤ 3 cm and segmental resection possible) and tested its effect on cancer-specific mortality (CSM). Methods: Within the SEER database (2004–2021), we identified PC patients undergoing PLND and tabulated the number of lymph nodes (LNs) removed according to PC eligibility. Multivariable Cox-regression models tested the effect of PLND extent on CSM after adjusting for age, sex, T stage, N stage, and chemotherapy. Results: Of 1017 PC patients undergoing PLND, 197 (19.4%) were eligible vs. 820 (80.6%) ineligible according to PC eligibility criteria. Median number of LNs removed at PLND was 6 (IQR: 3–11) in eligible versus 7 (IQR: 3–14) in ineligible patients (p = 0.09). Mean numbers of LNs removed at PLND increased over the study period, from 7 to 16 (p = 0.007) in PC-eligible and from 8 to 13 (p = 0.001) in PC-ineligible patients. In 1017 patients regardless of PC eligibility, 5-year CSM-free survival rate was 65.6%, and PLND extent predicted lower CSM (multivariable hazard ratio [mHR]: 0.99, p = 0.036). In 197 PC-eligible patients, 5-year CSM-free survival rate was 84.2%, and the PLND extent was not associated with CSM (mHR: 0.96, p = 0.2). Conversely, in 820 PC-ineligible patients, 5-year CSM-free survival rate was 61.1%, and PLND extent predicted lower CSM (mHR: 0.99, p = 0.043). Conclusion: In all PC patients regardless of eligibility status, more extensive PLND was associated with improved cancer-specific survival.