Impact of lymph node dissection on cancer specific survival in patients with upper tract urothelial carcinoma treated with radical nephroureterectomy.
OBJECTIVE
We examined the impact of lymphadenectomy on the clinical outcomes of patients with upper tract urothelial cancer treated with radical nephroureterectomy.


METHODS
Data were collected on 1,130 consecutive patients with pT1-4 upper tract urothelial cancer treated with radical nephroureterectomy at 13 centers worldwide. Patients were grouped according to nodal status (pN0 vs pNx vs pN+). The choice to perform lymphadenectomy was determined by the treating surgeon. All pathology slides were reevaluated by dedicated genitourinary pathologists. Univariable and multivariable Cox regression models measured the association of nodal status (pN0 vs pNx vs pN+) with cancer specific survival.


RESULTS
Overall 412 patients (36.5%) had pN0 disease, 578 had pNx disease (51.1%) and 140 had pN+ disease (12.4%). The 5-year cancer specific survival estimate was lower in patients with pN+ compared to those with pNx disease (35% vs 69%, p <0.001), which in turn was lower than that in those with pN0 disease (69% vs 77%, p = 0.024). In the subgroup of patients with pT1 disease (345) cancer specific survival rates were not different in those with pN0 and pNx. In pT2-4 cases (813) cancer specific survival estimates were lowest in pN+, intermediate in pNx and highest in pN0 (33% vs 58% vs 70%, p = 0.017). When adjusted for the effects of standard clinicopathological features pN+ was an independent predictor of cancer specific survival (p <0.001). pNx was significantly associated with worse prognosis than pN0 in pT2-4 upper tract urothelial cancer only.


CONCLUSIONS
Nodal status is a significant predictor of cancer specific survival in upper tract urothelial cancer. pNx is significantly associated with a worse prognosis than pN0 in pT2-4 tumors. Patients expected to have pT2-4 disease should undergo lymphadenectomy to improve staging and thereby help guide decision making regarding adjuvant chemotherapy.
Roscigno
Marco
M
Vita-Salute University San Raffaele, Milan, Italy. roscigno.marco@hsr.it
Shariat
Shahrokh F
SF
Margulis
Vitaly
V
Karakiewicz
Pierre
P
Remzi
Mesut
M
Kikuchi
Eiji
E
Langner
Cord
C
Lotan
Yair
Y
Weizer
Alon
A
Bensalah
Karim
K
Raman
Jay D
JD
Bolenz
Christian
C
Guo
Charles C
CC
Wood
Christopher G
CG
Zigeuner
Richard
R
Wheat
Jeffrey
J
Kabbani
Wareef
W
Koppie
Theresa M
TM
Ng
Casey K
CK
Suardi
Nazareno
N
Bertini
Roberto
R
Fernández
Mario I
MI
Mikami
Shuji
S
Isida
Masaru
M
Michel
Maurice Stephan
MS
Montorsi
Francesco
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000401:mortality* / Q000556:secondary / Q000601:surgery*; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009392:Nephrectomy; D015996:Survival Rate; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000401:mortality* / Q000601:surgery*