Leilei Xia, MD, on the role of extended lymph node dissection post-S1011 trial

In this video, Leilei Xia, MD, touches on the background and key findings from the study, “Level of nodal metastasis in patients undergoing radical cystectomy and lymphadenectomy: Is there a role of extended lymphadenectomy in the post-S1011 era?” These findings were presented at the Society of Urologic Oncology 25th Annual Meeting in Dallas, Texas. Xia is a urologic oncology fellow at the University of Southern California in Los Angeles.

Video Transcript:

Could you highlight the key findings from the S1011 trial and the rationale for this follow-up study?

S1011 is a huge effort from SWOG, led by Dr. Seth Lerner. Actually, my program director, Dr. Daneshmand [was involved] that trial to contribute to a lot of patients. It took a few years; I believe it's close to 10 years. It basically showed for muscle-invasive urothelial cancer of the bladder [in] patients who are undergoing radical cystectomy, the extended lymph node dissection had no benefit. Not only that, the adverse events in the extended lymph node dissection group were actually higher than the standard. That's the main take home message is less more for lymph node dissection in the setting of muscle-invasive bladder cancer for radical cystectomy. The rationale behind our study is—it's a retrospective study—we’re trying to find out what's the mechanism behind why there's no benefit. For lymph node dissection, we try to investigate into 2 directions, 1 therapeutic benefit, another one is diagnostic benefit. So, that's our rationale behind this study.

What were the key findings from the current study?

We looked at our database from 2002 to 2023 [at] all the patients who under[went] radical cystectomy with lymph node dissection at USC. All patients underwent the super extended lymph node dissection, we included those patients. We stratified the patients into 3 different cohorts in terms of lymph node metastasis in different levels. The level 1 would be the equivalent of standard limited dissection for the S1011, would be the external iliac, internal iliac obturator nodes. The level 2 will be the common iliac, pre-sciatic, and the pre-sacral nodes, and the level 3 will be the paracaval and paraaortic nodes.

We included about 740 patients—about 159 had lymph node positive disease. And 100 patients had level 1 metastasis. The rest, [approximately] 50, was level 2 or level 3. Our key finding is that the lymph node metastasis doesn’t skip that much. Among the 159 patients who had lymph node metastasis, only 7 had a skip lymph node, which means they had level 2 or level 3 without having level 1. That gave us the idea that the diagnostic benefit of extended lymph node detection was pretty minimal. It's less than 5%, 4.4% to be exact.

Then we also looked into the therapeutic benefit of extended lymph node dissection, which shows, basically, if you have a level 2 or level 3 metastasis after radical cystectomy and lymph node dissection, if you don't go through chemotherapy, which is common practice for metastatic disease, then most patients will die within 2 years. Among the 16 patients, I think 88% died within 2 years, [and] about 65% of patients died within 1 year. That gave us the idea that the therapeutic benefit is very marginal too. Those are systemic disease, and they need a systemic therapy.

This transcript was AI generated and edited by human editors for clarity.