Role of lymph node dissection in the treatment of urothelial carcinoma of the upper urinary tract: Multi-institutional relapse analysis and immunohistochemical re-evaluation of negative lymph nodes

Abe, Takashige; Shinohara, Nobuo; Muranaka, Masanori; Sazawa, Ataru; Maruyama, Satoru; Osawa, Takahiro; Harabayashi, Toru; Kubota, Kanako; Matsuno, Yoshihiro; Shibata, Takeshi; Toyada, Y.; Shinno, Yuki; Minami, Keita; Sakashita, Shigeo; Kumagai, Akira; Takada, Norikata; Tomita, Masaki; Sano, Hiroshi; Mori, T.; Nonomura, Katsuya

doi:10.1016/j.ejso.2010.08.134

Cited by 50 publications

(50 citation statements)

References 10 publications

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“…As a mechanism for this type of risk reduction, Roscigno et al (4) hypothesizes that lymphadenectomy may remove microcancer deposits in the lymph nodes that cannot be detected by routine pathological examination with hematoxylin and eosin staining. This hypothesis is confirmed in a study by Abe et al (5) in which they examined nodal specimens with immunohistochemistry using anticytokeratin antibodies. Of 51 patients with pN0 from routine pathological examinations, 7 (13.7%) showed micrometastases in the lymph nodes detected by immunohistochemical staining.…”

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confidence: 65%

Possible Role of Template-based Lymphadenectomy in Reducing the Risk of Regional Node Recurrence after Nephroureterectomy in Patients with Renal Pelvic Cancer

Kondo

Hara

Takagi

et al. 2014

Japanese Journal of Clinical Oncology

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Objective: It remains unclear whether lymphadenectomy alters regional node recurrence after nephroureterectomy in patients with urothelial carcinoma of the renal pelvis. The predictive factors for regional node recurrence are still unclear. In this study, we retrospectively examined how the extent of lymphadenectomy influences regional node recurrence in patients with urothelial carcinoma of the renal pelvis. Methods: From January 1988 through July 2013, we performed nephroureterectomy in 180 patients with non-metastatic (cN0M0) urothelial carcinoma of the renal pelvis at two Japanese institutes. Regional nodes were determined according to our previous mapping study: complete lymphadenectomy designates that all regional sites were dissected; incomplete lymphadenectomy that all sites were not dissected. A third group included those without lymphadenectomy. Results:The 5-year cancer-specific and recurrence-free survival was significantly higher in the complete lymphadenectomy group than in the incomplete lymphadenectomy or without lymphadenectomy groups (P ¼ 0.03). The incidence of regional node recurrence was significantly lower in the complete lymphadenectomy group at 2.9% (2/67) than in the incomplete lymphadenectomy at 18.1% (4/22) or without lymphadenectomy at 10.9% (10/91) groups (P ¼ 0.03). In patients with incomplete lymphadenectomy, 75% of regional node recurrence occurred outside of the dissected sites. Complete lymphadenectomy is shown to be a likely predictive factor of reduced risk of recurrence at the regional nodes by multivariate analysis, after adjusting for patient age, pathological T stage, and pathological nodal metastases. Conclusions: This study shows that template-based lymphadenectomy reduced the risk of regional node recurrence in patients with urothelial carcinoma of the renal pelvis and appears to result in improved survival.

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confidence: 65%

Possible Role of Template-based Lymphadenectomy in Reducing the Risk of Regional Node Recurrence after Nephroureterectomy in Patients with Renal Pelvic Cancer

Kondo

Hara

Takagi

et al. 2014

Japanese Journal of Clinical Oncology

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“…Brausi et al [32] also showed that retroperitoneal LND significantly improved the survival of patients with muscle invasive disease. Abe et al [33] also reported that skipping LND (pNx) was an adverse factor not only for locoregional recurrence, but also for distant relapse. A recent multicenter study also showed that patients with pN0 showed better survival than those with pNx [34].…”

Section: The Therapeutic Value Of Lymphadenectomy In Ucuutmentioning

confidence: 96%

“…The incidence of nodal involvement was 8% in pT2, 27% in pT3, and 79% in pT4. Abe et al [33] showed that a potential therapeutic benefit of LND resulted from eliminating micrometastases detected by immunohistochemistry but not by regular H&E staining. Thus, one can speculate that LND for the disease Fig.…”

Section: Who Is a Candidate For Lnd In Ucuut?mentioning

confidence: 98%

The role of lymph node dissection in the management of urothelial carcinoma of the upper urinary tract

Kondo

Tanabe

2011

Int J Clin Oncol

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Urothelial carcinoma of the upper urinary tract (UCUUT) is a disease with poor prognosis and a high incidence of lymphatic metastasis at 30-40%. Lymphadenectomy may be a possible surgical strategy to control the spread of lymphatic cancer, but its therapeutic benefit in UCUUT has remained controversial in contrast to bladder cancer in which consensus has been almost reached with respect to the necessity of extended lymphadenectomy. We hypothesized that radical lymphadenectomy may also be important for UCUUT since UCUUT is histologically similar to bladder cancer. One of the major reasons for uncertainty about whether lymphadenectomy has any therapeutic value may have resulted from an incomplete understanding of the regional nodes. Thus, we started our analyses by clarifying this issue, and found that the primary sites of lymphatic metastases encompassed a relatively wide area, especially on the right side, when compared with the conventional recognition. We further reported complete lymphadenectomy in which all regional sites which were dissected appeared to provide a survival benefit for patients with UCUUT at an advanced stage. To date, several studies from the other institutes have added supportive evidence for the therapeutic role of lymphadenectomy. Although there are several points to be determined such as the extent of the template, the minimum number of lymph nodes removed, or the candidate for lymphadenectomy, performing lymphadenectomy is unlikely to have a negative effect on the patient. In the future, we expect that controlled prospective studies will further clarify the potential role of lymphadenectomy in UCUUT.

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“…The majority of previously published studies suggest than LND is less common in patients undergoing minimally invasive compared with open nephroureterectomy [although with similar lymph node counts (median ¼ 8 nodes) and CSS] [81][82][83], but these are small series with variable dissection templates [84,85]. A single randomized trial has been performed comparing laparoscopic and open nephroureterectomy, but LND was not performed [86].…”

Section: Upper Tract Urothelial Cancermentioning

confidence: 93%

Comparative effectiveness of minimally invasive versus open lymphadenectomy in urological cancers

Prasad

Shalhav

2013

Current Opinion in Urology

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Role of lymph node dissection in the treatment of urothelial carcinoma of the upper urinary tract: Multi-institutional relapse analysis and immunohistochemical re-evaluation of negative lymph nodes

Cited by 50 publications

References 10 publications

Possible Role of Template-based Lymphadenectomy in Reducing the Risk of Regional Node Recurrence after Nephroureterectomy in Patients with Renal Pelvic Cancer

Possible Role of Template-based Lymphadenectomy in Reducing the Risk of Regional Node Recurrence after Nephroureterectomy in Patients with Renal Pelvic Cancer

The role of lymph node dissection in the management of urothelial carcinoma of the upper urinary tract

Comparative effectiveness of minimally invasive versus open lymphadenectomy in urological cancers

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