Potential benefit of lymph node dissection during radical nephroureterectomy for upper tract urothelial carcinoma: A systematic review by the European Association of Urology Guidelines Panel on non-muscle-invasive bladder cancer

Escrig, J.L. Domínguez; Peyronnet, B.; Seisen, Thomas; Bruins, H.M.; Yuan, Chen; Babjuk, M.; Böhle, Andreas; Burger, Max M.; Compérat, Eva; Lam, Thomas; MacLennan, Sara; Mostafid, Hugh; Palou, Joan; Sylvester, R. J.; Zigeuner, Richard; Shariat, Shahrokh F.; Rouprêt, Morgan

doi:10.1016/s1569-9056(18)32043-8

Cited by 15 publications

(29 citation statements)

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“…For LND vs no LND patients, the 5-year OS rates and CSS rates were 41. 5 was consistent across all tumor stages for both OS and CSS. Kaplan-Meier plots depicting OS and CSS rates, after stratification according to LND status, LND extent and lymph node stage were shown in Figure 1A, Figure 1B and Figure 1C respectively.…”

Section: Survival Analyses According To Lnd Statusmentioning

confidence: 63%

“…At NU, lymph node dissection (LND) allows for optimal tumor staging and improves the detection accuracy of lymph node metastases (LNM) [3,4]. Moreover, LND might have a potential benefit on survival outcomes for advanced-stage UTUC patients [5]. However, there were some disadvantages resulting from LND such as long surgical time and increased postoperative complications [6].…”

Section: Introductionmentioning

confidence: 99%

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

Zhai

Jin

Zhou

et al. 2019

Preprint

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Objectives 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). Methods Overall, 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. Results LND 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). Conclusion LND was more frequently performed in locally advanced UTUC patients. The beneficial effect of LND especially LND with 4 or more regional lymph nodes removed on survival was more significant in these patients than those with pT1 or pT2 disease. LND at UN should always be contemplated, regardless of tumor stage.

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Section: Survival Analyses According To Lnd Statusmentioning

confidence: 63%

Section: Introductionmentioning

confidence: 99%

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

Zhai

Jin

Zhou

et al. 2019

Preprint

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“…Effects of other factors such as incomplete surgery, venous invasion, G stage [31], and tumor locations [15] on local recurrence were debated. In UTUC, template-based lymphadenectomy appears to improve CSS and reduces the risk of local recurrence in patients with advanced tumor stage [16]. But nowadays, LND is not routinely performed during RNU [18,32].…”

Section: Discussionmentioning

confidence: 99%

“…Factors such as multiple tumor focal, incomplete surgery, LVI, tumor grade, and T stage were found associated with local recurrence [9,14,15]. Template-based and complete LND was not routinely performed, which may also cause the high local recurrence rate in high-risk patients [16]. Metastasis patterns of UTUC with different primary tumor locations were different [17].…”

Section: Introductionmentioning

confidence: 99%

Pattern and risk factors of local recurrence after nephroureterectomy for upper tract urothelial carcinoma

Cui

et al. 2020

World J Surg Onc

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Purpose: This study aims to identify predictive local recurrence risk factors and site-specific local recurrence pattern of upper tract urothelial carcinoma (UTUC) with different primary tumor locations. Methods: Three hundred and eighty-nine UTUC patients with radical nephroureterectomy were included in this study. Univariate and multivariate Cox proportional hazards regressions were performed to measure the risk of local recurrence. We also mapped the position of local recurrence sites stratified by primary tumor locations. Results: A total of 73 patients (18.7%) developed local recurrence within a median follow-up of 41 months (range, 3-80 months). For patients with local recurrence, the median interval of local recurrence was 9 months. Ureter tumor, multifocality, T stage, G grade, lymph node metastasis (LNM), lymph node dissection (LND), and lymph vascular invasion (LVI) were all significantly associated with increased local recurrence by univariable analyses (P < 0.05). Only multifocality, T3-4, G3, and LNM remained independent predictors of increased local recurrence by multivariable analyses. Adjuvant radiotherapy could reduce the local recurrence (HR = 0.177; 95% CI 0.064-0.493, P = 0.001). Patients with local recurrence had poorer cancer-specific survival (4-year cancer-specific survival rate 36 ± 7.5% vs 88.4 ± 2.2%, P = 0.000). We evaluated local recurrence pattern stratified by tumor locations. Para-aortic lymph node region was the most common recurrence area for all the patients. Left-sided UTUC had more than 70% recurrent lymph nodes in the left para-aortic region (LPA). For right-sided UTUC patients, recurrent para-aortic lymph nodes distributed in the LPA (33.3%), aortocaval (AC) (41.5%), and right paracaval (RPC) (25.2%) regions. Recurrence in the internal and external iliac regions was only found in the distal ureter group (P < 0.05). Renal pelvic fossa recurrence was only found in renal pelvic tumor (22.2%, P = 0.007). The ureter tumor bed recurrence rate was higher for ureter patients (P = 0.001). Conclusions: Multifocality, T3-4, G3, and LNM are predictors of higher local recurrence rate of UTUC. Adjuvant radiotherapy can reduce local recurrence rate. Local recurrence patterns are different according to primary tumor locations.

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“…At NU, lymph node dissection (LND) allows for optimal tumor staging and improves the detection accuracy of lymph node metastases (LNM) [3, 4]. Moreover, LND might have a potential benefit on survival outcomes for advanced-stage UTUC patients [5]. However, there are some disadvantages resulting from LND such as long surgical time and increased postoperative complications [6].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

View full text Add to dashboard Cite

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.

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Potential benefit of lymph node dissection during radical nephroureterectomy for upper tract urothelial carcinoma: A systematic review by the European Association of Urology Guidelines Panel on non-muscle-invasive bladder cancer

Cited by 15 publications

References 0 publications

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

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

Pattern and risk factors of local recurrence after nephroureterectomy for upper tract urothelial carcinoma

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

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