Introduction: Radical cystectomy with pelvic node dissection remains the standard of care for muscle-invasive bladder carcinoma (MIBC); however, there is a growing interest in bladder preservation alternatives among the elderly population. Guidelines indicate that partial cystectomy (PC) combined with pelvic node dissection (LND) can be considered as an alternative in carefully selected individuals. Using the National Cancer Database, we analyzed the overall survival (OS) between PC with and without LND among octogenarians.
Methods: We identified octogenarians with localized muscle-invasive bladder carcinoma (cT2-3N0M0) and urothelial histology who underwent PC with or without LND between 2004 and 2018. Based on the number of lymph nodes removed (LNR), the LND group was further subdivided into <10 and >=10 lymph node groups. A propensity-matched Kaplan-Meier survival analysis was performed to compare OS between these groups.
Results: Among 2573 patients who underwent PC, 492 octogenarians met our selection criteria. 208 (42.2%) had LND, while 284 (57.8%) had no LND. Within the LND group, 53 (25.5%) had <10 LNR, and 155 (74.5%) had >=10 LNR. The median OS for the matched LND and non-LND groups was 36.9 and 33.4 months (p = 0.96), respectively. Similarly, <10 LNR and >=10 LNR had 36.9 and 43.5 months (p = 0.42), respectively. Multivariate Cox regression analysis revealed no difference in the risk of mortality.
Conclusion: Among octogenarians who underwent PC, there was no significant difference in OS between those with or without LND, and between <10 or >=10 LNR groups. Therefore, the role and extent of LND after PC need further exploration in this subset of the population.
Keywords: elderly; muscle-invasive bladder cancer; octogenarian; partial cystectomy; pelvic node dissection.
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