Abstract
This multicenter, retrospective study evaluated the impact of pelvic lymph node dissection (PLND) on survival outcomes in non-muscle invasive bladder cancer (NMIBC) patients undergoing radical cystectomy (RC) and identified factors associated with upstaging. A total of 544 NMIBC patients who underwent RC with or without PLND between 2019 and 2024 were analyzed. Survival outcomes, including cancer-specific survival (CSS) and recurrence-free survival (RFS), were compared using Kaplan-Meier analysis and Cox proportional hazards models, while factors associated with upstaging were examined through logistic regression. Of the 544 patients, 509 (93.6%) were staged as cT1, and 412 (75.7%) underwent PLND. Upstaging occurred in 193 patients (35.5%), with pathological stages distributed as pT1 (50.0%), pT2 (20.8%), pT3 (11.2%), and pT4 (3.5%). Among patients who underwent PLND, 29 (7.0%) had positive lymph nodes. PLND was associated with improved RFS (5-year: 84.3% vs. 71.5%; adjusted hazard ratio [HR] = 0.33, 95% confidence interval [CI]: 0.20-0.56, p < 0.001) but did not significantly impact CSS (5-year: 86.5% vs. 81.6%; adjusted HR = 0.57, 95% CI: 0.32-1.02, p = 0.06). Lymph node positivity was linked to the worst prognosis. cT1 tumors, histological subtypes, and PLND were significant predictors of upstaging. In patients with cT1 tumors or histological subtypes, repeat transurethral resection is recommended to obtain more precise staging, which may inform further therapeutic decisions. While PLND is not routinely recommended for all NMIBC patients, it may be considered in those with high-risk features, particularly cT1 tumors or histological subtypes.