We assessed the extent of pelvic lymph node dissection (PLND) at partial cystectomy (PC) according to PC eligibility (≤cT2 stage, tumor ≤ 3 cm and segmental resection possible) and tested its effect on cancer-specific mortality (CSM).
Within the SEER database (2004-2021), we identified PC patients undergoing PLND and tabulated the number of lymph nodes (LNs) removed according to PC eligibility. Multivariable Cox-regression models tested the effect of PLND extent on CSM after adjusting for age, sex, T stage, N stage, and chemotherapy.
Of 1017 PC patients undergoing PLND, 197 (19.4%) were eligible vs. 820 (80.6%) ineligible according to PC eligibility criteria. Median number of LNs removed at PLND was 6 (IQR: 3-11) in eligible versus 7 (IQR: 3-14) in ineligible patients (p = 0.09). Mean numbers of LNs removed at PLND increased over the study period, from 7 to 16 (p = 0.007) in PC-eligible and from 8 to 13 (p = 0.001) in PC-ineligible patients. In 1017 patients regardless of PC eligibility, 5-year CSM-free survival rate was 65.6%, and PLND extent predicted lower CSM (multivariable hazard ratio [mHR]: 0.99, p = 0.036). In 197 PC-eligible patients, 5-year CSM-free survival rate was 84.2%, and the PLND extent was not associated with CSM (mHR: 0.96, p = 0.2). Conversely, in 820 PC-ineligible patients, 5-year CSM-free survival rate was 61.1%, and PLND extent predicted lower CSM (mHR: 0.99, p = 0.043).
In all PC patients regardless of eligibility status, more extensive PLND was associated with improved cancer-specific survival.
International journal of urology : official journal of the Japanese Urological Association. 2026 May [Epub]
Mattia Longoni, Andrea Marmiroli, Fabian Falkenbach, Quynh Chi Le, Michele Nicolazzini, Calogero Catanzaro, Federico Polverino, Jordan A Goyal, Markus Graefen, Gennaro Musi, Felix K H Chun, Carlotta Palumbo, Riccardo Schiavina, Nicola Longo, Fred Saad, Shahrokh F Shariat, Marco Moschini, Giorgio Gandaglia, Francesco Montorsi, Alberto Briganti, Pierre I Karakiewicz
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy., Department of Urology, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany., Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Maggiore Della Carità Hospital, Novara, Italy., Department of Urology, University of Bologna, St. Orsola-Malpighi Hospital, Bologna, Italy., Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy., Department of Urology, Weill Cornell Medical College, New York, New York, USA., Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy.