title: The impact of lymph node status and features on oncological outcomes in urothelial carcinoma of the upper urinary tract (UTUC) treated by nephroureterectomy.
abstract: OBJECTIVE
  Prognostic impact of lymphadenectomy during radical nephroureterectomy (RNU) for urothelial carcinoma of the upper urinary tract (UTUC) is controversial. Our aim was to assess the impact of lymph node status (LNS) on survival in patients treated by RNU.
  
  
  METHODS
  In our multi-institutional, retrospective database, 714 patients with non-metastatic UTUC had undergone RNU between 1995 and 2010. LNS was tested as prognostic factor for survivals through univariate and multivariable Cox regression analysis.
  
  
  RESULTS
  Median age was 70 years [interquartile range (IQR), 60-75] with median follow-up of 27 months (IQR, 10-50). Overall, lymphadenectomy was performed in 254 patients (35.5 %). Among these patients, 204 (80 %) had negative lymph nodes (pN0) and 50 (20 %) had positive lymph nodes (pN1/2). The 5-year cancer-specific survival (CSS) was 81 % [95 % confidence interval (CI), 73-88 %] for pN0 patients, 85 % (95 % CI, 80-90 %) for pNx patients and 47 % (95 % CI, 24-69 %) for pN1/2 patients (p < 0.001). Metastasis-free survival (MFS) and overall survival (OS) rates were significantly lower in pN1/2 patients than in pN0 and pNx patients (p < 0.05). On multivariable analysis, LNS did not appear as an independent prognostic factor for CSS, OS or MFS (p > 0.05). In case of lymph node involvement, extra-nodal extension was marginally associated with worse CSS (log rank p = 0.07). The retrospective design was the main limitation.
  
  
  CONCLUSIONS
  LNS is helpful for survival stratification in patients treated with RNU for UTUC. However, LNS did not appear as an independent predictor of survival in this retrospective series and needs to be investigated in a large multicentre, prospective evaluation.
authors.affiliation: Academic Department of Urology, CHU Lille, Univ Lille Nord de France, 59000, Lille, France. adil-ouzzane@orange.fr
authors.forename: Adil
authors.initials: A
authors.lastname: Ouzzane
authors.forename: Pierre
authors.initials: P
authors.lastname: Colin
authors.forename: Tarek P
authors.initials: TP
authors.lastname: Ghoneim
authors.forename: Marc
authors.initials: M
authors.lastname: Zerbib
authors.forename: Alexandre
authors.initials: A
authors.lastname: De La Taille
authors.forename: François
authors.initials: F
authors.lastname: Audenet
authors.forename: Fabien
authors.initials: F
authors.lastname: Saint
authors.forename: Nicolas
authors.initials: N
authors.lastname: Hoarau
authors.forename: Emilie
authors.initials: E
authors.lastname: Adam
authors.forename: Marie Dominique
authors.initials: MD
authors.lastname: Azemar
authors.forename: Henri
authors.initials: H
authors.lastname: Bensadoun
authors.forename: Luc
authors.initials: L
authors.lastname: Cormier
authors.forename: Olivier
authors.initials: O
authors.lastname: Cussenot
authors.forename: Alain
authors.initials: A
authors.lastname: Houlgatte
authors.forename: Gilles
authors.initials: G
authors.lastname: Karsenty
authors.forename: Charlotte
authors.initials: C
authors.lastname: Maurin
authors.forename: François Xavier
authors.initials: FX
authors.lastname: Nouhaud
authors.forename: Véronique
authors.initials: V
authors.lastname: Phe
authors.forename: Thomas
authors.initials: T
authors.lastname: Polguer
authors.forename: Mathieu
authors.initials: M
authors.lastname: Roumiguié
authors.forename: Alain
authors.initials: A
authors.lastname: Ruffion
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D007682:Kidney Pelvis; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D009392:Nephrectomy; D010388:Pelvis; D012189:Retrospective Studies; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery; D014516:Ureteral Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery