Open Access

ARTICLE

Survival outcomes with pelvic node dissection after partial cystectomy among octogenarians with muscle-invasive bladder cancer

Arjun Pon Avudaiappan^*, Pushan Prabhakar, Hannah Baker, Mukesh K. Roy, Manuel Ozambela Jr, Christopher Gomez, Murugesan Manoharan

Department of GU Surgical Oncology, Miami Cancer Institute, 8900 N Kendall Drive, Miami, FL 33176, USA

* Corresponding Author: Arjun Pon Avudaiappan. Email:

Canadian Journal of Urology 2025, 32(3), 137-143. https://doi.org/10.32604/cju.2025.064725

Received 22 February 2025; Accepted 16 May 2025; Issue published 27 June 2025

Abstract

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.

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