Urothelial cancer: Practice-changing results
Why is there no added benefit to extended pelvic lymph node dissection (ePLND)? The Plenary Session on day 4 of EAU24 featured two practice-changing trials in locally advanced bladder cancer and was chaired by Prof. Silke Gillessen Sommer (CH) and Dr. Maria Carmen Mir Maresma (ES).
LEA lymph node dissection trial update
“We all know the extent of lymph node dissection (LND) in BCa patients undergoing radical cystectomy (RC) may affect survival rates according to retrospective studies,” stated Prof. Jürgen Gschwend (DE) in his presentation ‘LEA lymph node dissection trial update’.
Prof. Gschwend summarised the follow up results: “Extended lymph node dissection (eLND) failed to show a significant advantage over standard LND (sLND) for the primary endpoint time to progression (TTP); and eLND had higher morbidity (lymfoceles) and perioperative mortality. “The cause-specific survival endpoint was significantly improved with longer follow-up, which can be meaningful for patients. Quality of PLND during RC does matter, but higher lymph node (LN) counts are not necessarily better.”
SWOG S1011 Results
“The objective of the trial is to compare disease-free survival (DFS) in patients undergoing radical cystectomy for muscle-invasive urothelial carcinoma of the bladder (UCB) treated with RC and eLND compared to RC and standard pelvic lymphadenectomy”, stated Prof. Seth Lerner (US) in his presentation of the phase III SWOG S1011 results.
In his summary of findings, Prof. Lerner illustrated that patients undergoing RC and eLND had a higher node yield but similar pathologic T stage. The eLND was associated with a higher median number of positive nodes among N+ patients and higher N3 stage. There was no indication of DFS or overall survival benefit for eLND compared to patients undergoing sLND (sLND was associated with higher local pelvic recurrence in N+ patients. And lastly, eLND was associated with greater morbidity and higher peri-operative mortality, with longer OR time, higher blood loss, and a higher number of progression events within 90 days and higher VTE rate.
According to Prof. Lerner, the standard of care based on SWOG S1011 and LEA trials is bilateral sLND for patients with cT2-4a/NO-2 urothelial cancer.
To (re)watch the full presentations of this Plenary Session, please visit the EAU24 Resource Centre.