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Thomas Flaig, MD


ASCO 2023: Comparing Types of Lymphadenectomy in Surgical Treatment of Muscle-Invasive Urothelial Cancer

By: Jenna Carter, PhD
Posted: Thursday, June 29, 2023

Seth P. Lerner, MD, FACS, of Baylor College of Medicine, Houston, and colleagues assessed whether undergoing an extended versus standard lymphadenectomy would improve the disease-free survival and overall survival of patients with muscle-invasive urothelial cancer undergoing radical cystectomy. Their findings, which were presented at the 2023 American Society of Clinical Oncology (ASCO) Annual Meeting (Abstract 4508), revealed no differences in these survival outcomes between the two lymphadenectomy approaches.

A total of 616 eligible patients with cT2–4a N0–2 were stratified by receipt and type of neoadjuvant chemotherapy and randomly assigned on a 1:1 basis to receive either a standard bilateral pelvic lymphadenectomy or an extended lymphadenectomy. The investigators hypothesized that patients in the extended arm would have a 10% improvement in 3-year disease-free survival compared with an estimated 55% for patients in the standard arm. Hazard ratios from a Cox model were used to assess the primary and secondary endpoints, which included overall and disease-free survival.

Findings revealed that the clinical stage was balanced in both arms: T2 (71%) and T3–4a (29%); however, the pathologic T stage was less than T2 in 39% of the standard arm and less than T2 in 37% of the extended arm. The median number of lymph nodes removed was higher in the extended arm than in the standard arm (41 vs. 25), but there were no differences in node metastasis (26% vs. 24%, respectively). Additionally, there were more patients in the extended arm with N2 or N3 disease, and there was an increase in grade 3 or 4 adverse events in the extended versus the standard arm (16% vs. 8%, respectively). Survival analyses revealed no differences between the arms in disease-free survival (hazard ratio [HR] = 1.10; 95% confidence interval [CI] = 0.87–1.42) and overall survival (HR = 1.15; 95% CI = 0.89–1.48), one-sided log rank P = .87.

Disclosure: For full disclosures of the study authors, visit

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