Retroperitoneal lymph node dissection (RPLD) in conjunction with nephroureterectomy in the treatment of infiltrative transitional cell carcinoma (TCC) of the upper urinary tract: impact on survival.
OBJECTIVE
To evaluate the prognostic impact of retroperitoneal lymph node dissection (RPLD) performed during nephroureterectomy on time to recurrence and survival in patients with infiltrative transitional cell carcinoma (TCC) of the upper urinary tract.


METHODS
The charts of 82 patients with T2-T4 TCC of the upper tract were retrospectively reviewed. The median patient age was 67.7 yr. Seventy-nine patients underwent nephroureterectomy and three had partial nephrectomy. Forty patients (48.8%) had RPLD with removal of more than five nodes after nephroureterectomy (group 1), whereas 42 (51.2%) had nephroureterectomy only (group 2). Median follow-up was 64.7 mo. The prognostic role of RPLD, T (2 vs. 3-4), G (2 vs. 3), N (0 vs. 1-2 vs. x), age (<65 vs. >65 yr) and sex on time to recurrence and survival were evaluated.


RESULTS
Median time to recurrence and overall survival were 51.2 and 52.5 mo, respectively, in group 1 and 18.5 and 21.2 mo in group 2. Univariate analysis demonstrated that RPLD and T and N status were significantly related both to time to recurrence (p=0.009, 0.008, and 0.009, respectively) and survival (p=0.000006, 0.003, and 0.003). When analyzed using the Cox proportional hazard model, RPLD and T category were the only two factors demonstrating independent significance on overall survival (p=0.004 and 0.008).


CONCLUSIONS
The results indicate a possible curative role of RPLD in the treatment of patients with infiltrative TCC of the upper urinary tract. Further randomized trials are needed to confirm these results.
Brausi
Maurizio A
MA
Department of Urology, AUSL Modena, Carpi (Modena), Italy. brausi@interfree.it
Gavioli
Mirko
M
De Luca
Giuseppe
G
Verrini
Giorgio
G
Peracchia
Giancarlo
G
Simonini
Gianluca
G
Viola
Massimo
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014571:Urologic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*