Impact of Lymph Node Dissection on Cancer Specific Survival in Patients With Upper Tract Urothelial Carcinoma Treated With Radical Nephroureterectomy

Marco Roscigno, Shahrokh F. Shariat, Vitaly Margulis, Pierre Karakiewicz, Mesut Remzi, Eiji Kikuchi, Cord Langner, Yair Lotan, Alon Weizer, Karim Bensalah, Jay D. Raman, Christian Bolenz, Charles C. Guo, Christopher G. Wood, Richard Zigeuner, Jeffrey Wheat, Wareef Kabbani, Theresa M. Koppie, Casey K. Ng, Nazareno SuardiRoberto Bertini, Mario I. Fernández, Shuji Mikami, Masaru Isida, Maurice Stephan Michel, Francesco Montorsi

Research output: Contribution to journalArticlepeer-review

136 Scopus citations

Abstract

Purpose: We examined the impact of lymphadenectomy on the clinical outcomes of patients with upper tract urothelial cancer treated with radical nephroureterectomy. Materials and Methods: Data were collected on 1,130 consecutive patients with pT1-4 upper tract urothelial cancer treated with radical nephroureterectomy at 13 centers worldwide. Patients were grouped according to nodal status (pN0 vs pNx vs pN+). The choice to perform lymphadenectomy was determined by the treating surgeon. All pathology slides were reevaluated by dedicated genitourinary pathologists. Univariable and multivariable Cox regression models measured the association of nodal status (pN0 vs pNx vs pN+) with cancer specific survival. Results: Overall 412 patients (36.5%) had pN0 disease, 578 had pNx disease (51.1%) and 140 had pN+ disease (12.4%). The 5-year cancer specific survival estimate was lower in patients with pN+ compared to those with pNx disease (35% vs 69%, p <0.001), which in turn was lower than that in those with pN0 disease (69% vs 77%, p = 0.024). In the subgroup of patients with pT1 disease (345) cancer specific survival rates were not different in those with pN0 and pNx. In pT2-4 cases (813) cancer specific survival estimates were lowest in pN+, intermediate in pNx and highest in pN0 (33% vs 58% vs 70%, p = 0.017). When adjusted for the effects of standard clinicopathological features pN+ was an independent predictor of cancer specific survival (p <0.001). pNx was significantly associated with worse prognosis than pN0 in pT2-4 upper tract urothelial cancer only. Conclusions: Nodal status is a significant predictor of cancer specific survival in upper tract urothelial cancer. pNx is significantly associated with a worse prognosis than pN0 in pT2-4 tumors. Patients expected to have pT2-4 disease should undergo lymphadenectomy to improve staging and thereby help guide decision making regarding adjuvant chemotherapy.

Original languageEnglish (US)
Pages (from-to)2482-2489
Number of pages8
JournalJournal of Urology
Volume181
Issue number6
DOIs
StatePublished - Jun 1 2009

Keywords

  • carcinoma
  • lymph node excision
  • prognosis
  • survival
  • transitional cell
  • urologic neoplasms

ASJC Scopus subject areas

  • Urology

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