OBJECTIVE: To compare extended versus non-extended PLND and their influence on recurrence-free survival (RFS) in patient undergoing radical cystectomy for bladder cancer.
METHODS: Through a comprehensive searching of PubMed, Embase, and the Cochrane Library databases in September 2012, we performed a systematic review and cumulative meta-analysis of all comparative studies assessing the extent of PLND and its influence on RFS.
RESULTS: Six studies including 2824 patients were identified. On overall analysis, a significantly better RFS was observed in extended PLND (e-PLND) compared with non e-PLND (HR: 0.65; p ＜0.001). On subgroup analysis, compared with non e-PLND, e-PLND was associated with better RFS for both lymph node negative (LN-) (HR: 0.68; p = 0.007) and positive (LN+) (HR: 0.58; p＜0.001) patients. When stratified by pathologic T stage, e-PLND could provide additional RFS benefits for pT3-4 patients (HR: 0.61; p＜0.001), but not for ≤ pT2 patients (HR: 0.95; p = 0.81).
CONCLUSIONS: The results of this meta-analysis indicate that e-PLND provides more RFS benefit compared with non e-PLND. On subgroup analysis, e-PLND provides better RFS for not only LN+ patients, pT3-4 patients, but also LN- patients. Two RCTs are awaited to provide more clinically meaningful results for this topic.
Written by:
Fan X, Huang H, Bi L, Li K, Xu K, Jiang C, Liu H, Dong W, Zhang S, Yang X, Lin T, Huang J. Are you the author?
Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-sen University, Guangzhou, China.
Reference: BJU Int. 2013 Jul 19. Epub ahead of print.
doi: 10.1111/bju.12371
PubMed Abstract
PMID: 24053715
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