Effect of lymph node dissection on the outcomes of upper tract urothelial carcinomas: a meta-analysis

Yang, Deyong; Chen, Qiwei; Song, Xishuang; Wang, Jianbo; Che, Xiangyu; Zhu, Zheng; Zheng, Wei; Wang, Lina

doi:10.1586/14737140.2014.895670

Cited by 20 publications

(10 citation statements)

References 24 publications

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“…The use of cisplatin‐based chemotherapy for high‐risk UTUC is preferable in a neoadjuvant setting because of the possible significant loss of renal function after radical nephroureterectomy (RNU), which may render a patient unfit for such chemotherapy 5 . Further, extended lymph node dissection (LND) benefits patients with locally advanced UTUC 6 . Thus, preoperative tools for predicting pathological outcomes are urgently required to identify patients with UTUC who are eligible for neoadjuvant chemotherapy (NAC), extended LND, or both.…”

Section: Introductionmentioning

confidence: 99%

Development and external validation of a preoperative nomogram for predicting pathological locally advanced disease of clinically localized upper urinary tract carcinoma

et al. 2020

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Objective: To develop and validate a preoperative nomogram to predict pathological locally advanced disease (pLAD) of clinically localized upper urinary tract urothelial carcinoma (UTUC) treated with extirpative surgery. Methods: In total, 1101 patients with cN0M0 UTUC (development cohort, n = 604; validation cohort, n = 497) from 2 independent academic databases were retrospectively analyzed. pLAD was defined as pT3/4 and/or pN+. Multivariate logistic regression was used to develop a nomogram. The accuracy of the nomogram was evaluated with a receiver operating characteristic curve, calibration plot, and decision curve analysis. Results: The development and validation cohorts comprised 204 (33.8%) and 178 (35.8%) patients with pLAD, respectively. The multivariate analyses showed that the neutrophil-to-lymphocyte ratio (hazard ratio [HR], 2.27; P < .001), chronic kidney 3734 | YOSHIDA et Al.

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Section: Introductionmentioning

confidence: 99%

Development and external validation of a preoperative nomogram for predicting pathological locally advanced disease of clinically localized upper urinary tract carcinoma

et al. 2020

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“…However, the results of comparisons in previous publications are controversial (11). Yang et al (20) showed no significant difference in survival between patients with and without LND in a meta-analysis. Similarly, no significant difference was observed between the LND and no-LND groups in the current study.…”

Section: Discussionmentioning

confidence: 97%

“…We noted the presence of cT stage heterogeneity between these two groups. Moreover, several reports have suggested that CSS is higher in patients with than without LND only among patients with muscle-invasive disease (20,21). Therefore, we carried out a subgroup analysis of patients with clinically muscleinvasive UTUC.…”

Section: Discussionmentioning

confidence: 99%

Impact of lymph node dissection on clinical outcomes during nephroureterectomy in patients with clinically node-negative upper urinary tract urothelial cancer: subanalysis of a multi-institutional nationwide case series of the Japanese Urological Association

Inokuchi

Eto

Hara

et al. 2017

Japanese Journal of Clinical Oncology

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Objective: To evaluate the impact of lymph node dissection (LND) on the clinical outcomes during radical nephroureterectomy (RNU) in patients with clinically node-negative upper urinary tract urothelial cancer (UTUC). Methods: Within the nationwide case series of the Japanese Urological Association, which comprises 1509 patients with UTUC diagnosed in 2005, we identified 823 patients with clinically nodenegative UTUC who underwent RNU. The extent of limited LND was defined as the renal hilar region only for renal pelvic cancer and as either the pelvic region or para-aortic/paracaval region only for ureteral cancer, while the extent of wider LND was defined as at least one perilesional LND region in addition to limited LND. Multivariate analysis with a Cox regression hazard model was used to evaluate the survival benefit. Results: Among the 823 patients, LND was performed in 197 (23.9%) patients, and 26 (13.2%) of them had pathologically node-positive disease. Of 197 patients who underwent LND, limited and wider LND was performed in 119 (60.4%) and 78 (39.6%) patients, respectively. Patients with node-positive disease showed significantly shorter overall survival than those with node-negative disease. No LND-associated survival improvement was observed in a direct comparison between patients with and without LND. In addition, limited or wider LND was not associated with overall survival or cancer-specific survival. Conclusions: The therapeutic benefit obtained by LND remains unclear regardless of the extent of LND, although LND has diagnostic value with respect to the prediction of a poor prognosis especially in patients with clinically muscle-invasive disease.

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“…A meta-analysis on the effect of LND on outcomes of UTUC showed improved survival, particularly for locally advanced tumors. 17 …”

Section: Discussionmentioning

confidence: 99%

Patterns of Lymphatic Metastases in Upper Tract Urothelial Carcinoma and Proposed Dissection Templates

et al. 2015

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Purpose Information on patterns of lymph node metastases (LNM) for upper tract urothelial carcinoma (UTUC) is sparse. We investigate patterns of LNM in UTUC. Materials/Methods Retrospective multi-institutional study of 73 patients with N+M0 UTUC undergoing template lymphadenectomy during nephroureterectomy. Anatomic locations of tumor, number of lymph nodes removed, positive lymph nodes were analyzed and descriptive statistics performed. Results On right side: renal pelvis tumors (n=20) had LNM to the hilum (22.1%), paracaval (44.1%), retrocaval (10.3%) and interaortocaval (20.6%) regions. Proximal ureter tumors (n=10) had LNM to hilum (46.2%), paracaval (46.2%), and retrocaval (7.7%) regions. Distal ureter tumors (n=2) had LNM equally to paracaval and pelvic regions. On left side: patients with renal pelvis tumors (n=24) had LNM to hilar (50.0%), and paraaortic (30.0%) regions. Proximal ureter tumors (n=8) had LNM to hilar (36.4%) and paraaortic (63.6%) regions. Mid ureter tumors (n=5) had LNM to paraaortic (40%), common iliac (40%) and internal iliac (20%) regions. Distal ureter tumors (n=4) had LNM to paraaortic (33.3%), common iliac (33.3%), and external and internal iliac (16.7% each). Interaortocaval involvement from both sides as well as out-of-field LNM appeared to occur secondarily. Consolidated templates were constructed based on the available data. Conclusion UTUC has characteristic patterns of LNM dependent on the side and anatomic location of the primary tumor, including right to left migration and involvement of interaortocaval nodes in the setting of proximal disease. Standardized dissection templates should be prospectively evaluated in multi-center trials to assess for morbidity and potential clinical benefit.

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Effect of lymph node dissection on the outcomes of upper tract urothelial carcinomas: a meta-analysis

Cited by 20 publications

References 24 publications

Development and external validation of a preoperative nomogram for predicting pathological locally advanced disease of clinically localized upper urinary tract carcinoma

Development and external validation of a preoperative nomogram for predicting pathological locally advanced disease of clinically localized upper urinary tract carcinoma

Impact of lymph node dissection on clinical outcomes during nephroureterectomy in patients with clinically node-negative upper urinary tract urothelial cancer: subanalysis of a multi-institutional nationwide case series of the Japanese Urological Association

Patterns of Lymphatic Metastases in Upper Tract Urothelial Carcinoma and Proposed Dissection Templates

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