Effect of lymph node dissection on stage-specific survival in patients with upper urinary tract urothelial carcinoma treated with nephroureterectomy

Abstract

BackgroundWe aimed to estimate the stage-specific impact of lymph node dissection (LND) on survival for upper urinary tract urothelial carcinoma (UTUC) patients treated with nephroureterectomy (NU).MethodsOverall, 7278 UTUC patients undergoing NU within the SEER database from 2004 to 2015 were identified. Kaplan-Meier plots illustrated overall survival (OS) and cancer-specific survival (CSS) rates according to LND status. Multivariable Cox regression analyses assessed the effect of LND on OS and CSS rates stratified by pathological tumor stage.ResultsLND was performed in 26.9% of patients, and in 18.6, 23.3, 31.2 and 45.9% for pT1, pT2, pT3 and pT4 patients, respectively (P < 0.001). In multivariable Cox regression analyses, LND was associated with a higher OS or CSS in UTUC patients with pT3 and pT4 disease (all P < 0.05), but failed to achieve independent predictor status in patients with pT1 and pT2 disease (all P > 0.05). LND with 1 to 3 regional lymph nodes removed was prone to a higher OS or CSS only in pT4 compared to no LND (both P < 0.01). LND with 4 or more regional lymph nodes removed predisposed to a higher OS or CSS in pT3 or pT4 (all P < 0.05).ConclusionsThe beneficial effect of LND especially LND with 4 or more regional lymph nodes removed on survival was evident in pT3/4 patients. LND can be considered for pT3 and pT4, for pT1/2 remains to be seen, both of which will be verified by further prospective studies.

Lymph Node Dissection During Radical Nephro-Ureterectomy for Upper Tract Urothelial Carcinoma: A Review

“…Similarly, the disease-specific survival (DSS) rates were 72.1 vs. 29.8% (HR = 2.9; 1.47–6.01) and overall survival (OS) rates were 66 vs. 22.3% (HR = 2.97; 1.47–6.01). In another study conducted among preoperatively node-negative patients, CSS and OS rates were higher in pN0 patients compared to those with pNx and pN1–3 disease, and these results were consistent across all tumor stages ( 33 ). Thus, pN+ patients' harbor decreased survival rates compared to pN0, highlighting the negative prognostic impact of lymph node involvement.…”

“…The indication of LND and its extent must be discussed as the impact of lymphadenectomy itself on survival is to be proven. Zhai et al studied the effect of LND during RNU on cancer-specific survival and overall survival ( 33 ). They retrospectively analyzed 7,278 patients from SEER database with histologically proven UTUC, who underwent RNU with or without LND.…”

Clinical Efficacy of Adjuvant Chemotherapy in Advanced Upper Tract Urothelial Carcinoma (pT3-T4): Real-World Data from the Taiwan Upper Tract Urothelial Carcinoma Collaboration Group

“…Nodal dissection has a controversial therapeutic role, and the procedure is performed if nodal metastasis is defined in the clinical image. Dominguez-Escrig et al, Don et al, and Zhai et al reported that LND had a survival benefit in patients with high stage (≥pT2) UTUC and reduced the risk of local recurrence [22][23][24]. Guo et al demonstrated that LND during RUN provides more accurate pathological staging and prediction of prognosis [25].…”

The prognostic value of tumor architecture in patients with upper tract urothelial carcinoma treated with radical nephroureterectomy

“…[ 3 , 4 ] The reported 5-year recurrence-free survival (RFS) and cancer-specific survival (CSS) rates are 50% to 80% and 70% to 74.4%, respectively. [ 5 – 7 ] Great efforts have been made to improve the understanding of UTUC, but the management for UTUC still remains a big challenge. These unfavorable results highlight the importance of developing a therapeutic strategy to improve the prognosis of UTUC.…”