Systematic regional lymph node dissection for upper tract urothelial carcinoma improves patient survival

Furuse, Hiroshi; Matsushita, Yuto; Yajima, Takashi; Kato, Taiki; Suzuki, Takahisa; Matsumoto, Rikiya; Motoyama, Daisuke; Sugiyama, Tetsuya; Otsuka, Atsushi; Ozono, Seiichiro

doi:10.1093/jjco/hyw179

Cited by 8 publications

(24 citation statements)

References 24 publications

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“…There were no randomised controlled trials (RCTs). In all, 21 studies [24][25][26][27][28][29][30]32,33,36,38,39,[41][42][43][44][45][46][47][48][49] collected data retrospectively, one paper [37] collected data prospectively, and one paper [31] collected data both retrospectively and prospectively. In all, 17 papers included details of cohorts who had not undergone LND as a comparative cohort [24,27,28,[31][32][33][35][36][37][39][40][41][42][43]45,47,50].…”

Section: Resultsmentioning

confidence: 99%

“…In all, 23 papers [24][25][26]28,[30][31][32][33][34][35][36][37][38][39][40][41][42][43][44]46,47,49,50] included patients regardless of pT stage, two papers included patients only with pT2-4 disease [27,29], and one paper only included patients with pT4 disease [48]. One paper [45] did not include data on pT stage of the patients included.…”

Section: Patient Demographicsmentioning

confidence: 99%

“…In all, 12 studies presented data on RFS after LND [26,28,[30][31][32]36,[41][42][43][47][48][49]. Most of these papers reported RFS at 5 years from surgery.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…In all, 16 papers reported CSS [26,28,[30][31][32]34,36,37,[39][40][41][42][43]45,48,49]. Nine studies provided 5-year CSS comparing patients who underwent LND (3628 patients) with patients who did not (3597) [28,33,36,[39][40][41][42][43]45].…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…In all, 16 studies [24][25][26][27][28][29][30]32,33,35,[41][42][43][44][45]48] reported no set template for LND and extent was determined by the operating surgeon, two studies [34,37] reported an anatomical template for LND, and four studies [31,36,38,39] included patients with a mixture of LND performed at the discretion of the operating surgeon and following an anatomical template. It was not clear in five of the studies [40,46,47,49,50] whether or not LND was according to a pre-determined template.…”

Section: Surgical Resectionmentioning

confidence: 99%

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Lymph node dissection during nephroureterectomy: Establishing the existing evidence based on a review of the literature

Grimes

McKay

Lee

et al. 2019

Arab Journal of Urology

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To determine the role of lymph node dissection (LND) in the treatment of upper tract transitional cell carcinoma (UTTCC), as the role of LND along with nephroureterectomy in treating UTTCC is unclear and several retrospective studies have been published on this topic with conflicting results. Methods: The Medical Literature Analysis and Retrieval System Online (MEDLINE), the Excerpta Medica dataBASE (EMBASE), Cochrane Central Register of Controlled Trials database (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Clinicaltrials. gov, Google Scholar, and individual urological journals, were searched for all studies investigating the role of LND in the treatment of UTTCC. Of the studies identified, those that met inclusion criteria were included in this review. Results: In all, 27 studies were included in this review, with 9303 patients who underwent LND. No randomised controlled trials (RCTs) were identified. Tumours were located in the renal pelvis in 62% of patients, in the ureter in 35.5%, and multifocal in 2.3%. In total: 77.1% were LN-negative and 22.9% had LN metastasis. For all patients undergoing LND, the 5-year recurrence-free survival (RFS) and cancer-specific survival (CSS) rates were 27-65.4% and 32.3-95%, respectively. For patients who underwent a LND in accordance with a standardised anatomical template, the 5-year RFS and CSS rates were 84.3-93% and 83.5-94%, respectively. Conclusion: LND may provide a survival benefit in patients undergoing nephroureterectomy for UTTCC, particularly if following a standardised anatomical template and in those patients with muscle-invasive disease; however, a prospective RCT is required to confirm this.

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Section: Resultsmentioning

confidence: 99%

Section: Patient Demographicsmentioning

confidence: 99%

“…In all, 12 studies presented data on RFS after LND [26,28,[30][31][32]36,[41][42][43][47][48][49]. Most of these papers reported RFS at 5 years from surgery.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Section: Surgical Resectionmentioning

confidence: 99%

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Lymph node dissection during nephroureterectomy: Establishing the existing evidence based on a review of the literature

Grimes

McKay

Lee

et al. 2019

Arab Journal of Urology

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Consultation on UTUC, Stockholm 2018: aspects of treatment

et al. 2019

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PurposeTo provide an overview of treatment modalities for management of upper tract urothelial carcinoma (UTUC).MethodsIn accordance with the standards for a scoping review, data presentation and discussion at the Consultation on UTUC in Stockholm, 6–7 September 2018, consensus was reached on the latest and most important treatment recommendations for UTUC. Using Pubmed, Web of Science, and Embase, publications were selected based on quality, clinical relevance, and level of evidence.ResultsKidney-sparing surgery should be attempted for low-grade UTUC. Radical nephroureterectomy with bladder cuff excision is first option for high-grade disease. Post-operative bladder instillation of chemotherapy should be offered after RNU to reduce intravesical recurrence rate. Identification of tumor grade and stage is crucial when selecting treatment. Ureteroscopic management of low-grade and non-invasive UTUC achieves disease-free survival similar to that offered by radical nephroureterectomy but seems to be a risk factor for intravesical recurrence. Lymphadenectomy appears important for high-risk disease, although the therapeutic benefit needs further validation. There is little evidence supporting use of Bacillus Calmette–Guérin (BCG) and mitomycin C as monotherapy and adjuvant treatment in UTUC. A randomized clinical trial has indicated that platin-based chemotherapy for invasive UTUC improves disease-free survival, suggesting that adjuvant chemotherapy should be considered standard care for ≥ T2 N0–3M0 disease.ConclusionsRisk stratification assessment is feasible and mandatory in UTUC. Identification of tumor grade and stage is essential for optimal treatment selection. Kidney-sparing surgery should be offered in low-risk disease, whereas radical nephroureterectomy and adjuvant chemotherapy should be considered in high-risk disease.

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Lymph Node Dissection in Upper Tract Urothelial Carcinoma: Current Status and Future Perspectives

Dłubak,

Karwacki,

Logoń

et al. 2023

Curr Oncol Rep

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Purpose of Review This narrative review aims to evaluate the role of lymph node dissection (LND) in upper tract urothelial carcinoma (UTUC) and its implications for staging and management outcomes, as well as future perspectives. Recent Findings Multiple studies have demonstrated the limitations of conventional imaging techniques in accurately localizing lymph node metastasis (LNM) in UTUC. While 18F-fluorodeoxyglucose positron emission tomography with computed tomography (18FDG-PET/CT) shows promise for preoperative LNM detection, its specificity is low. Alternative methods such as choline PET/CT and sentinel lymph node detection are under consideration but require further investigation. Additionally, various preoperative factors associated with LNM hold potential for predicting nodal involvement, thereby improving nodal staging and oncologic outcomes of LND. Several surgical approaches, including segmental ureterectomy and robot-assisted nephroureterectomy, provide a possibility for LND, while minimizing morbidity. Summary LND remains the primary nodal staging tool for UTUC, but its therapeutic benefit is still uncertain. Advances in imaging techniques and preoperative risk assessment show promise in improving LNM detection. Further research and multi-center studies are needed to comprehensively assess the advantages and limitations of LND in UTUC, as well as the long-term outcomes of alternative staging and treatment strategies.

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Systematic regional lymph node dissection for upper tract urothelial carcinoma improves patient survival

Cited by 8 publications

References 24 publications

Lymph node dissection during nephroureterectomy: Establishing the existing evidence based on a review of the literature

Lymph node dissection during nephroureterectomy: Establishing the existing evidence based on a review of the literature

Consultation on UTUC, Stockholm 2018: aspects of treatment

Lymph Node Dissection in Upper Tract Urothelial Carcinoma: Current Status and Future Perspectives

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