Prediction of true nodal status in patients with pathological lymph node negative upper tract urothelial carcinoma at radical nephroureterectomy

Evanguelos Xylinas, Michael Rink, Vitaly Margulis, Talia Faison, Evi Comploj, Giacomo Novara, Jay D. Raman, Yair Lotan, Bertrand Guillonneau, Alon Weizer, Armin Pycha, Douglas S. Scherr, Christian Seitz, Maxine Sun, Quoc Dien Trinh, Pierre I. Karakiewicz, Francesco Montorsi, Marc Zerbib, Mithat Gönen, Shahrokh F. Shariat

Research output: Contribution to journalArticle

25 Scopus citations


Purpose: The role of lymph node dissection is still controversial in patients treated with radical nephroureterectomy for upper tract urothelial cancer. We developed a pathological nodal staging model that allows quantification of the likelihood that a patient with pathologically node negative disease has, indeed, no lymph node metastasis. Materials and Methods: We analyzed data on 814 patients treated with radical nephroureterectomy and lymph node dissection, and estimated the sensitivity of pathological nodal staging using a β-binomial model. We developed a pathological nodal staging score that represents the probability that a case is correctly staged as node negative. Results: A median of 5 lymph nodes (range 1 to 46) was removed and 593 patients (73%) had pN0 disease. The probability of missing lymph node metastasis decreased as the number of nodes examined increased. If only a single node was examined, 44% of patients would have been misclassified as having pN0 disease while harboring lymph node metastasis. Even when 5 nodes were examined, 12% of patients would have been misclassified. The proportion of those with a positive node increased with advancing pathological T stage and lymphovascular invasion. Patients with pT0-Ta-Tis-T1/lymphovascular invasion had more than a 95% chance of correct pathological nodal staging with 2 examined nodes. However, if a patient had pT3-T4 and positive lymphovascular invasion, even 20 examined lymph nodes did not attain 95% accuracy. Conclusions: Lymph node dissection provides more accurate staging and prediction of survival. The number of examined nodes needed for adequate staging depends on pT stage and lymphovascular invasion. We developed a tool to estimate the likelihood of false-negative lymph node metastasis, which could help refine clinical decision making regarding the administration of adjuvant chemotherapy.

Original languageEnglish (US)
Pages (from-to)468-473
Number of pages6
JournalJournal of Urology
Issue number2
Publication statusPublished - Feb 2013



  • carcinoma
  • forecasting
  • lymph node dissection
  • urinary tract
  • urothelium

ASJC Scopus subject areas

  • Urology

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