盆腔淋巴结切除术 (PLND) 与根治性膀胱切除术 (RC) 一起为膀胱癌患者提供重要的诊断和治疗价值。随着新辅助化疗的出现和支持标准 PLND 的前瞻性数据，关于最佳 PLND 范围和患者选择仍然存在争议。尽管 25% 的患者在 RC 时淋巴结 (LN) 呈阳性，但近 40% 的患者可能没有接受足够的 PLND。我们假设 PLND 仍然是膀胱癌治疗的一个重要方面。为了阐明淋巴结产量的预后重要性，我们对接受 RC 的异质群体 (pTanyNx/0M0) 患者进行了回顾性调查。根据监测、流行病学和最终结果 (SEER) 计划，我们确定了 pTanyNx/0M0 膀胱癌患者从 2004 年到 2015 年进行 RC。Kaplan Meier 曲线和 Cox 比例风险模型评估了癌症特异性生存。以 PLND 作为主要协变量对患者进行分析。然后，生存分析根据 LN 产量（作为连续变量和分类变量（≤10、11-20、21-30 和 >30））和 T 分期对接受 PLND 的患者进行分层。最终队列包括 pTanyNx/0M0 膀胱尿路上皮患者癌症（n=12,096）；中位随访时间为 39（IQR：17-77）个月。 81.45% 的患者进行了 PLND，中位 LN 产量为 14（IQR：7-23）。最常见的是，患者患有 T2 疾病（44.68%）。在控制年龄和 T 分期后，与未接受 PLND 的患者相比，接受 PLND 的患者 CSS 有所改善（HR=0.56，[95% CI：0.51-0.62]）。当按 LN 产量对患者进行分组时，生存率以“剂量依赖性”方式改善（>30 LN：HR=0.76，[95% CI：0.66-0.87]）。我们在将患者分为非肌层浸润性膀胱癌 (NMIBC) 和肌层浸润性膀胱癌 (MIBC) 时注意到了类似的结果。在当代 pTanyNx/0M0 膀胱癌患者的大型系列研究中，我们发现 PLND 具有显着的肿瘤学益处。较高的 LN 产量与非肌肉侵袭性和肌肉侵袭性疾病中 CSS 的改善相关。我们的数据支持即使在非肌肉侵袭性疾病中也存在隐匿性微转移的可能性。此外，鉴于辅助免疫治疗的最新进展，我们的结果强调了足够的淋巴结产量对于准确分期和最佳治疗的重要性。版权所有 © 2023 Elsevier Inc. 保留所有权利。

Pelvic lymphadenectomy (PLND) alongside radical cystectomy (RC), provides crucial diagnostic and therapeutic value in patients with bladder cancer. With the advent of neoadjuvant chemotherapy and prospective data supporting standard PLND, controversy remains regarding the optimal PLND extent and patient selection. Nearly 40% of patients may not receive adequate PLND, even though 25% of patients have positive lymph nodes (LN) at time of RC. We hypothesized that PLND still remains an important facet of bladder cancer treatment. To clarify the prognostic importance of nodal yield, we performed a retrospective investigation of a heterogenous population (pTanyNx/0M0) of patients undergoing RC.From the Surveillance, Epidemiology, and End Results (SEER) program, we identified pTanyNx/0M0 bladder cancer patients undergoing RC from 2004 to 2015. Kaplan Meier curves and Cox proportional hazards models assessed cancer-specific survival. Patients were analyzed with PLND performed as the primary covariate. Survival analysis then stratified patients undergoing PLND by LN yield, both as a continuous and categorial variable (≤10, 11-20, 21-30, and >30), and T stage.The final cohort included pTanyNx/0M0 patients with urothelial bladder cancer (n = 12,096); median follow up was 39 (IQR: 17-77) months. PLND was performed in 81.45% of patients with a median LN yield of 14 (IQR: 7-23). Most commonly, patients had T2 disease (44.68%). After controlling for age and T stage, patients receiving PLND had improved CSS (HR = 0.56, [95% CI: 0.51-0.62]) compared to those that did not receive PLND. When grouping patients by LN yield, survival improved in a "dose dependent" manner (>30 LN: HR = 0.76, [95% CI: 0.66-0.87]). We noted similar results when stratifying patients into non-muscle-invasive (NMIBC) and muscle-invasive bladder cancer (MIBC).In a large contemporary series of pTanyNx/0M0 bladder cancer patients, we found a significant oncologic benefit to PLND. Higher LN yield correlated to improved CSS in non-muscle-invasive and muscle-invasive disease. Our data support the possibility of occult micrometastasis even in non-muscle-invasive disease. Additionally, in light of recent advances in adjuvant immunotherapy, our results emphasize the importance of adequate nodal yield for accurate staging and optimal treatment.Copyright © 2023 Elsevier Inc. All rights reserved.