Prognostic Value of Extranodal Extension and Other Lymph Node Parameters in Patients With Upper Tract Urothelial Carcinoma

Fajković, Harun; Eugene, K.; Jeldres, Claudio; Donner, Gerhard; Chromecki, Thomas; Margulis, Vitaly; Novara, Giacomo; Lotan, Yair; Raman, Jay D.; Kassouf, Wassim; Seitz, Christian; Bensalah, Karim; Weizer, Alon Z.; Kikuchi, Eiji; Roscigno, Marco; Remzi, Mesut; Matsumoto, Kazumasa; Breinl, Eckart; Pycha, Armin; Ficarra, Vincenzo; Montorsi, Francesco; Karakiewicz, Pierre I.; Scherr, Douglas S.; Shariat, Shahrokh F.

doi:10.1016/j.juro.2011.10.158

Cited by 53 publications

(30 citation statements)

References 22 publications

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“…These results support the diagnostic value of LND in patients with cN0 disease by finding microscopic metastasis. However, the reported incidence of LN metastasis is 16% in patients with muscle-invasive disease, while LN metastasis is rare in those with non-muscle-invasive disease, and the increased incidence is reportedly related to the pT stage (12,13). In our cohort, the incidence of LN metastasis was 18% in patients with cT2-4 disease but only 6% in patients with ≤cT1 disease.…”

Section: Discussionmentioning

confidence: 53%

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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Section: Discussionmentioning

confidence: 53%

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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“…Previously, a small series demonstrated that a LN density 30% was an independent predictor of higher cancer-specific mortality, 15 although this finding was not replicated in a follow-up study. 16 An alternate explanation for the association between the number of negative LNs and survival among pN0 patients is that a thorough LND can be truly therapeutic if it eradicates unidentified microscopic foci of metastatic disease that are missed on routine pathologic examination. This hypothesis is supported by a recent study that reported finding micrometastatic disease using immunohistochemistry in 14% of patients with UTUC who were initially classified as having pN0 disease but later presented with disease recurrence.…”

Section: Discussionmentioning

confidence: 99%

Association between lymph node yield and survival among patients undergoing radical nephroureterectomy for urothelial carcinoma of the upper tract

Zareba

Rosenzweig

Winer

et al. 2017

Cancer

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Background Prior studies examining the value of lymph node dissection (LND) in patients with urothelial carcinoma of the upper urinary tract (UTUC) have produced conflicting results. The objective of this study was to assess the relationship between lymph node (LN) yield and survival among patients undergoing radical nephroureterectomy (RNU). Methods The National Cancer Data Base was used to identify patients with non-metastatic UTUC who were treated with RNU between 2004 and 2012. The association between LN yield and overall survival (OS) was assessed using Cox proportional hazards regression, with adjustment for patient, tumor and facility characteristics. Results Of the 14,472 patients, 2,926 (20%) underwent LND. Median yield was two LN (IQR 1, 6). Among the entire cohort and the LN-negative (pN0) subgroup, higher LN yield was associated with lower all-cause mortality (multivariable HR 0.94 per five LN removed, 95% CI 0.89, 1.00, p=0.034 for the entire cohort; HR 0.86, 95% CI 0.79, 0.94, p=0.001 for the pN0 subgroup). Among LN-positive (pN+) patients, there was no association between total LN yield and OS; however, positive and negative LN counts were independent predictors of OS (HR 1.27 per five positive LN, 95% CI 1.16, 1.39, p<0.001; HR 0.90 per five negative LN, 95% CI 0.82, 1.00, p=0.049). Conclusions In this large, contemporary cohort of patients with UTUC, LND was found to be used infrequently despite evidence that higher LN yield is associated with lower all-cause mortality.

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“…La gestion de la collerette vésicale au cours de la NUT [55] ainsi que la zone anatomique de dissection du curage ganglionnaire associé [56,57] étaient des facteurs pronostiques impactant la survie des patients. Ils sont traités dans un autre chapitre du rapport de l'AFU consacré au traitement chirurgical des TVES.…”

Section: Facteurs Chirurgicauxunclassified

Facteurs pronostiques des tumeurs de la voie excrétrice supérieure et impact sur la survie : une revue systématique pour le rapport annuel de l’Association française d’urologie

Colin

Irani

Drouin³

et al. 2014

Progrès en Urologie

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Prognostic Value of Extranodal Extension and Other Lymph Node Parameters in Patients With Upper Tract Urothelial Carcinoma

Cited by 53 publications

References 22 publications

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

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

Association between lymph node yield and survival among patients undergoing radical nephroureterectomy for urothelial carcinoma of the upper tract

Facteurs pronostiques des tumeurs de la voie excrétrice supérieure et impact sur la survie : une revue systématique pour le rapport annuel de l’Association française d’urologie

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