Radical cystectomy (RC) with pelvic lymphadenectomy (PLND) serves as the gold-standard treatment for muscle-invasive bladder cancer (MIBC). Numerous studies have shown that the number of lymph nodes (LN) removed during RC could affect patient prognosis. However, these studies confirmed the association between PLND and survival outcomes prior to the widespread adoption of neoadjuvant chemotherapy (NAC). Consequently, this study aimed to investigate the prognostic role of PLND in patients previously pretreated with NAC. A systematic review and meta-analysis were performed using PubMed, Web of Knowledge, and Scopus databases. The selected studies contained a total of 17,421 participants. The meta-analysis indicated a significant correlation between adequate PLND and overall survival in the non-NAC group. However, a survival benefit was not observed in patients undergoing RC with preoperative systemic therapy, regardless of the LN cut-off thresholds. The pooled HR for ≥10 and ≥15 LN were 0.87 (95% CI 0.75–1.01) and 0.87 (95% CI 0.76–1.00), respectively. The study results suggest that NAC mitigates the therapeutic significance of PLND, as patients pre-treated with NAC no longer gain oncological benefits from more extensive lymphadenectomy. This highlights the analogous roles of NAC and PLND in eradication of micrometastases and in prevention of distal recurrence post-RC.
根治性膀胱切除术（RC）联合盆腔淋巴结清扫术（PLND）是肌层浸润性膀胱癌（MIBC）的标准治疗方案。多项研究表明，RC术中清扫的淋巴结数量可能影响患者预后。然而，这些研究在新辅助化疗广泛应用之前便已确认了PLND与生存结局的关联。因此，本研究旨在探讨PLND对既往接受过新辅助化疗患者的预后价值。通过检索PubMed、Web of Knowledge和Scopus数据库，我们进行了系统综述与荟萃分析，共纳入涉及17,421名参与者的研究。荟萃分析显示，在未接受新辅助化疗的患者中，充分的PLND与总生存期显著相关；但对于术前接受全身治疗的患者，无论采用何种淋巴结数量阈值，均未观察到生存获益。当淋巴结阈值设定为≥10枚和≥15枚时，合并风险比分别为0.87和0.87。研究结果表明，新辅助化疗降低了PLND的治疗意义，因为接受过新辅助化疗的患者无法从更广泛的淋巴结清扫中获得额外的肿瘤学获益。这揭示了新辅助化疗与PLND在清除微转移灶、预防RC术后远处复发方面具有相似的作用机制。
肿瘤(癌症)患者之家