title: The extent of lymphadenectomy seems to be associated with better survival in patients with nonmetastatic upper-tract urothelial carcinoma: how many lymph nodes should be removed?
abstract: BACKGROUND
  The role and extent of lymphadenectomy in patients with upper-tract urothelial carcinoma (UTUC) is debated.
  
  
  OBJECTIVE
  To establish whether the number of lymph nodes (LNs) removed might be associated with better cause-specific survival in patients with UTUC.
  
  
  METHODS
  The study included 552 consecutive patients who underwent radical nephroureterectomy (RNU) and lymphadenectomy between 1992 and 2006.
  
  
  METHODS
  Patients were treated with RNU and lymphadenectomy.
  
  
  METHODS
  Univariable and multivariable Cox proportional hazards regression models addressed the association between the number of LNs removed and cause-specific mortality (CSM). The number of LNs removed was coded as a cubic spline to allow for nonlinear effects. Finally, the most informative cut-off for the number of removed LNs was identified.
  
  
  CONCLUSIONS
  In the entire population, the number of LNs removed was not associated with CSM in univariable (hazard ratio [HR]: 0.99; p=0.16) or in multivariable (HR: 0.97; p=0.12) analyses. In contrast, in the subgroup of pN0 patients (n=412), the number of LNs removed achieved the independent predictor status of CSM (HR: 0.93; p=0.02). Eight LNs removed was the most informative cut-off in predicting CSM (HR: 0.42; p=0.004). The inclusion of the variable defining dichotomously the number of removed LNs (< 8 vs > or = 8) in the base model (age, Eastern Cooperative Oncology Group performance status, pathologic stage, grade, architecture, and lymphovascular invasion) significantly increased the accuracy in predicting CSM (+1.7%; p<0.001).
  
  
  CONCLUSIONS
  The extension of the lymphadenectomy in pN0 UTUC patients seems to be associated with CSM. Longer survival was observed in patients in whom at least eight LNs had been removed.
authors: Vita Salute University San Raffaele, Milan, Italy. roscigno.marco@hsr.it
authors: Marco
authors: M
authors: Roscigno
authors: Shahrokh F
authors: SF
authors: Shariat
authors: Vitaly
authors: V
authors: Margulis
authors: Pierre
authors: P
authors: Karakiewicz
authors: Mesut
authors: M
authors: Remzi
authors: Eiji
authors: E
authors: Kikuchi
authors: Richard
authors: R
authors: Zigeuner
authors: Alon
authors: A
authors: Weizer
authors: Arthur
authors: A
authors: Sagalowsky
authors: Karim
authors: K
authors: Bensalah
authors: Jay D
authors: JD
authors: Raman
authors: Christian
authors: C
authors: Bolenz
authors: Wassim
authors: W
authors: Kassou
authors: Theresa M
authors: TM
authors: Koppie
authors: Christopher G
authors: CG
authors: Wood
authors: Jeffrey
authors: J
authors: Wheat
authors: Cord
authors: C
authors: Langner
authors: Casey K
authors: CK
authors: Ng
authors: Umberto
authors: U
authors: Capitanio
authors: Roberto
authors: R
authors: Bertini
authors: Mario I
authors: MI
authors: Fernández
authors: Shuji
authors: S
authors: Mikami
authors: Masaru
authors: M
authors: Isida
authors: Philipp
authors: P
authors: Ströbel
authors: Francesco
authors: F
authors: Montorsi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008197:Lymph Node Excision / Q000379:methods* / Q000706:statistics & numerical data; D008875:Middle Aged; D015996:Survival Rate; D014516:Ureteral Neoplasms / Q000601:surgery*