title: Systematic regional lymph node dissection for upper tract urothelial carcinoma improves patient survival.
abstract: OBJECTIVE
  Unlike for bladder cancer, the impact of regional lymph node dissection for upper tract urothelial carcinoma is unclear. We explored whether patient survival was influenced by systematic regional lymph node dissection, using resection templates according to the main tumor location, during radical nephroureterectomy for upper tract urothelial carcinoma.
  
  
  METHODS
  The systematic regional lymph node dissection group was defined as cases in which the dissection of nodes and surrounding tissues followed the established template, and the non-systematic regional lymph node dissection group as cases undergoing limited or no lymph node dissection. We performed radical nephroureterectomy on 98 consecutive patients with various stages of upper tract urothelial carcinoma from May 1994 to September 2014 at our institution. Of these, 77 patients with cTanyN0M0 of upper tract urothelial carcinoma undergoing radical nephroureterectomy were grouped into systematic regional lymph node dissection or non-systematic regional lymph node dissection cohorts according to the extent of dissection, and their outcomes compared.
  
  
  RESULTS
  Forty-four patients were categorized as systematic regional lymph node dissection and 33 as non-systematic regional lymph node dissection, including 17 with more limited nodal dissection and 16 with no nodal dissection. Five-year recurrence-free survival and cancer-specific survival were significantly higher in the systematic regional lymph node dissection (93% and 94%, respectively) than in the non-systematic regional lymph node dissection group (75% and 77% recurrence-free survival and cancer-specific survival, respectively). Further, 5-year recurrence-free survival and cancer-specific survival of muscle-invasive upper tract urothelial carcinoma (pT2-4) were significantly higher in the systematic regional lymph node dissection (87% and 91%, respectively) than in the non-systematic regional lymph node dissection group (59% and 62%, respectively) (P = 0.0237 and P = 0.0224). Neither recurrence-free survival nor cancer-specific survival was significantly prolonged by systematic dissection in patients with pTis-1 histology.
  
  
  CONCLUSIONS
  Systematic regional lymph node dissection during radical nephroureterectomy for cTanyN0M0 upper tract urothelial carcinoma patients has a significantly beneficial impact on survival compared with patients undergoing more limited dissection, especially in the cases involving muscle invasion.
authors.affiliation: Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Furuse
authors.affiliation: Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Yuto
authors.initials: Y
authors.lastname: Matsushita
authors.affiliation: Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yajima
authors.affiliation: Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Taiki
authors.initials: T
authors.lastname: Kato
authors.affiliation: Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Takahisa
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Rikiya
authors.initials: R
authors.lastname: Matsumoto
authors.affiliation: Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Motoyama
authors.affiliation: Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Sugiyama
authors.affiliation: Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Otsuka
authors.affiliation: Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Ozono
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D014571:Urologic Neoplasms / Q000401:mortality / Q000601:surgery*
keywords: kidney pelvis; lymph node dissection; survival; ureter; urogenital neoplasms