Extent of lymph node dissection and recurrence-free survival after radical cystectomy
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Extent of lymph node dissection and recurrence-free survival after radical cystectomy : a meta-analysis. / Mandel, Philipp; Tilki, Derya; Eslick, Guy D.
in: UROL ONCOL-SEMIN ORI, Jahrgang 32, Nr. 8, 11.2014, S. 1184-90.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Extent of lymph node dissection and recurrence-free survival after radical cystectomy
T2 - a meta-analysis
AU - Mandel, Philipp
AU - Tilki, Derya
AU - Eslick, Guy D
N1 - Copyright © 2014 Elsevier Inc. All rights reserved.
PY - 2014/11
Y1 - 2014/11
N2 - INTRODUCTION: Lymph node dissection (LND) at the time of radical cystectomy (RC) is the standard of care in the treatment of muscle-invasive bladder cancer. However, no final consensus about its optimal extent has been reached.METHODS: We conducted a meta-analysis to determine the effect of the extent of LND on 5-year recurrence-free survival and its complication rates in patients undergoing RC. A systematic search of MEDLINE, PubMed, and EMBASE has been performed. All studies published until June 2013 and providing information on 5-year recurrence-free survival were included in the analysis.RESULTS: We analyzed the recurrence-free survival data of 11 studies on standard or extended LND or both in patients undergoing RC. The extended (above the bifurcation of iliac vessels) LND showed a significant trend toward a higher proportion of lymph node-positive patients (odds ratio = 1.39; 95% CI: 0.96-2.00; P = 0.08). Including all studies that compare extended with standard LND, the overall odds ratio for the 5-year recurrence-free survival is 1.63 (95% CI: 1.28-2.07, P<0.001), showing a strong and statistical significant survival benefit for the group of patients who underwent extended LND. Moreover, the weighted average 5-year recurrence-free survival rate of all existing studies on standard LND is significantly different from the ones reporting extended LND rates. No differences in perioperative mortality or complication rates were reported.CONCLUSION: The present meta-analysis provides evidence to the positive effect of extended LND on recurrence-free survival and its diagnostic benefit in patients undergoing RC. Patients who underwent extended LND did not suffer from higher complication rates or perioperative mortality.
AB - INTRODUCTION: Lymph node dissection (LND) at the time of radical cystectomy (RC) is the standard of care in the treatment of muscle-invasive bladder cancer. However, no final consensus about its optimal extent has been reached.METHODS: We conducted a meta-analysis to determine the effect of the extent of LND on 5-year recurrence-free survival and its complication rates in patients undergoing RC. A systematic search of MEDLINE, PubMed, and EMBASE has been performed. All studies published until June 2013 and providing information on 5-year recurrence-free survival were included in the analysis.RESULTS: We analyzed the recurrence-free survival data of 11 studies on standard or extended LND or both in patients undergoing RC. The extended (above the bifurcation of iliac vessels) LND showed a significant trend toward a higher proportion of lymph node-positive patients (odds ratio = 1.39; 95% CI: 0.96-2.00; P = 0.08). Including all studies that compare extended with standard LND, the overall odds ratio for the 5-year recurrence-free survival is 1.63 (95% CI: 1.28-2.07, P<0.001), showing a strong and statistical significant survival benefit for the group of patients who underwent extended LND. Moreover, the weighted average 5-year recurrence-free survival rate of all existing studies on standard LND is significantly different from the ones reporting extended LND rates. No differences in perioperative mortality or complication rates were reported.CONCLUSION: The present meta-analysis provides evidence to the positive effect of extended LND on recurrence-free survival and its diagnostic benefit in patients undergoing RC. Patients who underwent extended LND did not suffer from higher complication rates or perioperative mortality.
KW - Cystectomy
KW - Disease-Free Survival
KW - Humans
KW - Lymph Node Excision
KW - Lymph Nodes
KW - Prognosis
KW - Treatment Outcome
KW - Urinary Bladder Neoplasms
KW - Journal Article
KW - Meta-Analysis
U2 - 10.1016/j.urolonc.2014.01.017
DO - 10.1016/j.urolonc.2014.01.017
M3 - SCORING: Journal article
C2 - 25027683
VL - 32
SP - 1184
EP - 1190
JO - UROL ONCOL-SEMIN ORI
JF - UROL ONCOL-SEMIN ORI
SN - 1078-1439
IS - 8
ER -