Extended PLND tied to improved survival in bladder cancer

In patients with bladder cancer, extended pelvic lymph node dissection (PLND) is associated with favourable recurrence-free survival and 5-year recurrence rates, a study has shown.

A team of investigators performed a comprehensive literature search of major databases from inception to November 2024 and identified studies comparing extended PLND (extended or super extended) with standard PLND. They extracted data for clinical outcomes and calculated pooled estimates using a random effects model with RevMan 5.4.

Eleven studies (two randomized controlled trials [RCTs] and nine observational), including 4,001 patients, met the eligibility criteria.

In the pooled analysis, extended PLND led to significantly better recurrence-free survival (hazard ratio [HR], 0.67, 95 percent confidence interval [CI], 0.60‒0.74). Standard PLND resulted in significantly higher 5-year recurrence rates (risk ratio, 1.44, 95 percent CI, 1.28‒1.62) than the extended approach.

Moreover, the pooled estimates were similar for disease-specific survival (HR, 0.86, 95 percent CI, 0.62‒1.19), overall survival (HR, 0.99, 95 percent CI, 0.86‒1.16), and complications between the two approaches.

“However, retrospective observational studies mainly drive the evidence, and additional RCTs are required to reach a definitive conclusion,” according to the investigators.

“For decades, PLND has been a critical component of radical cystectomy in patients with bladder cancer. Although its role in curative surgery for high-risk nonmuscle-invasive and muscle-invasive cases is well-established, the therapeutic advantages of extended PLND remain a topic of ongoing debate,” they said.