title: The contemporary role of lymph node dissection during nephroureterectomy in the management of upper urinary tract urothelial carcinoma: the Canadian experience.
abstract: OBJECTIVE
  To investigate the association between lymph node dissection (LND) and survival among patients undergoing nephroureterectomy for upper urinary tract urothelial cell carcinoma (UTUC).
  
  
  METHODS
  This study includes 1029 patients from 10 Canadian institutions who underwent nephroureterectomy between 1990 and 2010. Disease-specific survival (DSS), overall survival (OS), and recurrence-free survival (RFS) were compared for patients with a node-negative LND (N0), node-positive LND (N+), or no LND (Nx) using Kaplan-Meyer analysis and Cox regression analysis. The association between survival and number of positive nodes, number of nodes removed, and ratio of positive nodes to nodes removed was also investigated.
  
  
  RESULTS
  The median follow-up for the entire cohort was 19.8 months (interquartile range = 7.2-53.8). LND was performed in 276 (26.8%) patients, and 77 (27.9%) had N+ disease. Patients with N+ disease had significantly shorter OS, DSS, and RFS compared with N0 and Nx patients(P < .01). No differences were identified between N0 and Nx patients in any survival categories (P > .05). A ratio of positive nodes to nodes removed ≥ 20% had a per annum hazard ratio of 2.24 (95% confidence interval [CI] 1.18-4.65) for OS, 2.70 (95% CI = 1.25-5.83) for DSS, and 1.94 (95% CI = 1.13-3.32) for RFS. The number of positive nodes and the number of nodes removed were not associated with survival in any survival category (P > .05).
  
  
  CONCLUSIONS
  LND during nephroureterectomy provides more accurate staging and prediction of survival; however, it remains uncertain whether LND independently improves survival in patients with UTUC.
authors.affiliation: Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Ross J
authors.initials: RJ
authors.lastname: Mason
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
authors.forename: David G
authors.initials: DG
authors.lastname: Bell
authors.forename: Louis
authors.initials: L
authors.lastname: Lacombe
authors.forename: Anil
authors.initials: A
authors.lastname: Kapoor
authors.forename: Niels
authors.initials: N
authors.lastname: Jacobsen
authors.forename: Adrian
authors.initials: A
authors.lastname: Fairey
authors.forename: Jonathan
authors.initials: J
authors.lastname: Izawa
authors.forename: Peter
authors.initials: P
authors.lastname: Black
authors.forename: Simon
authors.initials: S
authors.lastname: Tanguay
authors.forename: Joseph
authors.initials: J
authors.lastname: Chin
authors.forename: Alan
authors.initials: A
authors.lastname: So
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Lattouf
authors.forename: Fred
authors.initials: F
authors.lastname: Saad
authors.forename: Edward
authors.initials: E
authors.lastname: Matsumoto
authors.forename: Darrel
authors.initials: D
authors.lastname: Drachenberg
authors.forename: Ilias
authors.initials: I
authors.lastname: Cagiannos
authors.forename: Yves
authors.initials: Y
authors.lastname: Fradet
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Rendon
mesh_terms: D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000473:pathology / Q000601:surgery; D014571:Urologic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D019459:Urothelium / Q000473:pathology