title: The role of lymph-node dissection in the treatment of upper urinary tract cancer: a multi-institutional study.
abstract: OBJECTIVE
  To determine the role of lymph-node (LN) dissection in patients undergoing surgery for upper urinary tract (UUT) cancer.
  
  
  METHODS
  We reviewed the clinicopathological data from 312 patients with UUT cancer treated predominantly by nephroureterectomy. The relationship between clinical characteristics and cancer-specific survival (CSS) was analysed, focusing on node-related information.
  
  
  RESULTS
  In all, 166 patients had LN dissection while 146 did not (pNx). Multivariate analysis showed that T stage, grade and pN status were significant variables for CSS. The difference in survival between the pN0 and pNx groups remained significant in a multivariate analysis. The median (range) number of LNs removed was 6 (1-65). There was no significant difference in CSS between the 72 patients with fewer than six LNs removed and the 78 with six or more removed.
  
  
  CONCLUSIONS
  LN dissection is important for postoperative stratification of patients with UUT cancer because node-positive disease was one of the variables with a significant adverse effect on survival. In addition, the significant difference in survival between the pN0 and pNx groups might indicate a therapeutic benefit of LN dissection, although removing more LNs did not uniformly increase the probability of CSS.
authors.affiliation: Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan. takataka@rf6.so-net.ne.jp
authors.forename: Takashige
authors.initials: T
authors.lastname: Abe
authors.forename: Nobuo
authors.initials: N
authors.lastname: Shinohara
authors.forename: Toru
authors.initials: T
authors.lastname: Harabayashi
authors.forename: Ataru
authors.initials: A
authors.lastname: Sazawa
authors.forename: Shuhei
authors.initials: S
authors.lastname: Ishikawa
authors.forename: Kanako
authors.initials: K
authors.lastname: Kubota
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Matsuno
authors.forename: Takahiro
authors.initials: T
authors.lastname: Osawa
authors.forename: Takeshi
authors.initials: T
authors.lastname: Shibata
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Shinno
authors.forename: Shinji
authors.initials: S
authors.lastname: Kamota
authors.forename: Keita
authors.initials: K
authors.lastname: Minami
authors.forename: Shigeo
authors.initials: S
authors.lastname: Sakashita
authors.forename: Ichiro
authors.initials: I
authors.lastname: Takeuchi
authors.forename: Akira
authors.initials: A
authors.lastname: Kumagai
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Mori
authors.forename: Masaki
authors.initials: M
authors.lastname: Togashi
authors.forename: Katsuya
authors.initials: K
authors.lastname: Nonomura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D016019:Survival Analysis; D014571:Urologic Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D019459:Urothelium / Q000473:pathology