The importance of pelvic lymph node dissection in the elderly population: implications for interpreting the 2010 National XXXX Network practice guidelines for bladder cancer treatment.

@entity5 @entity1 @entity797
PURPOSE: National @entity5 Network practice guidelines indicate that pelvic lymph node dissection can be omitted at radical cystectomy in elderly @entity1 . We examined the pelvic lymph node dissection rate in @entity1 80 years old or older and the impact of pelvic lymph node dissection on @entity5 specific and overall mortality in these @entity1 . MATERIALS AND METHODS: We examined the records of 11,183 @entity1 treated with radical cystectomy in 17 Surveillance, Epidemiology and End Results registries. We performed univariate and multivariate @entity797 regression analysis to test the effect of pelvic lymph node dissection on @entity5 specific and overall mortality. RESULTS: Overall pelvic lymph node dissection was omitted in 25% of @entity1 , including 24.2% younger than 80 years and 30.8% 80 years old or older (p <0.001). The 5-year rate of freedom from @entity5 specific mortality for pelvic lymph node dissection vs no pelvic lymph node dissection was 62.5% vs 59.9% in @entity1 younger than 80 years, and 50.0% vs 46.1% in those 80 years old or older (p = 0.01 and 0.005, respectively). The 5-year rate of freedom from overall mortality for the same categories was 48.8% vs 43.9% and 28.3% vs 24.7% (p <0.001 and 0.01, respectively). On multivariate analysis omitting pelvic lymph node dissection was associated with a 1.3-fold higher @entity5 specific rate at ages less than 80 and 80 years or greater (each p <0.001). Omitting pelvic lymph node dissection was also associated with a 1.3-fold higher overall mortality rate, including 1.3 at ages less than 80 years and 1.2-fold at ages 80 years or greater (each p  <=0.005). CONCLUSIONS: Results indicate that pelvic lymph node dissection was more often omitted in @entity1 80 years old or older than in those younger than 80 years. However, the protective effect of pelvic lymph node dissection on @entity5 specific and overall mortality was virtually the same in the 2 age categories. Thus, advanced age should not be a limiting factor for performing pelvic lymph node dissection at radical cystectomy.
