title: Template-based lymphadenectomy in urothelial carcinoma of the renal pelvis: a prospective study.
abstract: OBJECTIVE
  Recent studies showed the therapeutic benefit of lymphadenectomy in advanced stage urothelial carcinoma of the upper urinary tract, but there is still a lack of prospective studies and standardization of the extent of lymphadenectomy. The aim of this multi-institutional study was to examine the role of lymphadenectomy in urothelial carcinoma of the upper urinary tract.
  
  
  METHODS
  From January 2005 to September 2012, 77 patients undergoing nephroureterectomy and lymphadenectomy for non-metastatic (cN0M0) urothelial carcinoma of the upper urinary tract were included in a prospective study at two Japanese institutions(lymphadenectomy group). Lymphadenectomies were carried out according to definite anatomical template. Results from this group were compared with those from a control group of 89 patients who did not receive lymphadenectomy during the study period (no lymphadenectomy group).
  
  
  RESULTS
  In patients with urothelial carcinoma of the upper urinary tract in the renal pelvis of pathological stage 2 or higher, template-based lymphadenectomy resulted in significantly higher cancer-specific survival (89.8% and 51.7%, P = 0.01) and overall survival (86.1% and 48.0%, P = 0.01). Disease-free survival tended to be higher in the lymphadenectomy group(77.8% and 50.0%, P = 0.06). Template-based lymphadenectomy was a significant independent factor for reducing the risk of cancer death in patients with renal pelvic cancer of ≥ pT2 by multivariate analysis. In contrast, cancer-specific survival of patients with ureteral urothelial carcinoma of the upper urinary tract was not significantly different between the lymphadenectomy and no lymphadenectomy groups.
  
  
  CONCLUSIONS
  This multi-institutional prospective study further supports the therapeutic role of template-based lymphadenectomy in patients with advanced-stage urothelial carcinoma of the upper urinary tract in the renal pelvis. This is not the case for patients with ureteral urothelial carcinoma of the upper urinary tract.
authors.forename: Tsunenori
authors.initials: T
authors.lastname: Kondo
authors.forename: Isao
authors.initials: I
authors.lastname: Hara
authors.forename: Toshio
authors.initials: T
authors.lastname: Takagi
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Kodama
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Hashimoto
authors.forename: Hirohito
authors.initials: H
authors.lastname: Kobayashi
authors.forename: Junpei
authors.initials: J
authors.lastname: Iizuka
authors.forename: Kenji
authors.initials: K
authors.lastname: Omae
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Yoshida
authors.forename: Kazunari
authors.initials: K
authors.lastname: Tanabe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000556:secondary* / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D007682:Kidney Pelvis; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014516:Ureteral Neoplasms / Q000556:secondary* / Q000601:surgery*