title: Assessment of the minimum number of lymph nodes needed to detect lymph node invasion at radical nephroureterectomy in patients with upper tract urothelial cancer.
abstract: OBJECTIVE
  To determine whether a minimum number of lymph nodes (LNs) exist to detect lymph node invasion (LNI) in patients undergoing radical nephroureterectomy (RNU) for upper tract urothelial carcinoma.
  
  
  METHODS
  The study included 551 consecutive patients, from 13 centers worldwide, who underwent RNU and lymphadenectomy (LND) between 1992 and 2006. LND was performed at the discretion of the surgeon. All pathological slides were re-reviewed by uropathologists according to strict criteria. Receiver-operating characteristic curve coordinates were used to determine the probability of diagnosing LNI according to the total number of nodes removed. Additionally, the relationship between the number of nodes removed and the rate of positive LNs was tested in univariate and multivariate logistic regression models.
  
  
  RESULTS
  Median patient age was 68 years (range: 27-97). Of 551 patients, 140 (25.4%) had positive lymph nodes. Median number of lymph nodes removed was 5 (mean 6.7, range 1-41). The Receiver-operating characteristic coordinates plot indicated that the removal of 13 nodes yielded a 90% probability to detect >or=1 positive LNs. The removal of 8 nodes resulted in a 75% probability of finding >or=1 positive nodes. Removal of >8 LNs (P = .03; odds ratio 1.49) was independently associated with LNI after adjusting for pathological stage and grade.
  
  
  CONCLUSIONS
  Our data indicate that 8 LNs need to be removed at radical nephroureterectomy to achieve a 75% probability of finding >or=1 positive nodes. Further improvement of the specificity of LND will require the removal of more lymph nodes.
authors.affiliation: Department of Urology and Pathology, Vita-Salute University, Milan, Italy. roscigno.marco@hsr.it
authors.forename: Marco
authors.initials: M
authors.lastname: Roscigno
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Massimo
authors.initials: M
authors.lastname: Freschi
authors.forename: Vitaly
authors.initials: V
authors.lastname: Margulis
authors.forename: Pierre
authors.initials: P
authors.lastname: Karakiewizc
authors.forename: Nazareno
authors.initials: N
authors.lastname: Suardi
authors.forename: Mesut
authors.initials: M
authors.lastname: Remzi
authors.forename: Richard
authors.initials: R
authors.lastname: Zigeuner
authors.forename: Christian
authors.initials: C
authors.lastname: Bolenz
authors.forename: Eiji
authors.initials: E
authors.lastname: Kikuchi
authors.forename: Alon
authors.initials: A
authors.lastname: Weizer
authors.forename: Karim
authors.initials: K
authors.lastname: Bensalah
authors.forename: Arthur
authors.initials: A
authors.lastname: Sagalowsky
authors.forename: Theresa M
authors.initials: TM
authors.lastname: Koppie
authors.forename: Jay
authors.initials: J
authors.lastname: Raman
authors.forename: Mario
authors.initials: M
authors.lastname: Fernández
authors.forename: Philipp
authors.initials: P
authors.lastname: Ströbel
authors.forename: Wareef
authors.initials: W
authors.lastname: Kabbani
authors.forename: Cord
authors.initials: C
authors.lastname: Langner
authors.forename: Jeffery
authors.initials: J
authors.lastname: Wheat
authors.forename: Charles C
authors.initials: CC
authors.lastname: Guo
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
authors.forename: Andrea
authors.initials: A
authors.lastname: Haitel
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Wood
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000556:secondary* / Q000601:surgery*; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009392:Nephrectomy; D012189:Retrospective Studies; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000473:pathology* / Q000601:surgery*