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?
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.
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
Zigeuner
Richard
R
Weizer
Alon
A
Sagalowsky
Arthur
A
Bensalah
Karim
K
Raman
Jay D
JD
Bolenz
Christian
C
Kassou
Wassim
W
Koppie
Theresa M
TM
Wood
Christopher G
CG
Wheat
Jeffrey
J
Langner
Cord
C
Ng
Casey K
CK
Capitanio
Umberto
U
Bertini
Roberto
R
Fernández
Mario I
MI
Mikami
Shuji
S
Isida
Masaru
M
Ströbel
Philipp
P
Montorsi
Francesco
F
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*