BACKGROUND: Prior studies examining the value of lymph node (LN) dissection (LND) in patients with urothelial carcinoma of the upper urinary tract (UTUC) have produced conflicting results. The objective of the current study was to assess the relationship between 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, 2926 (20%) underwent LND. The median yield was 2 LNs (interquartile range 1-6 LNs). Among the entire cohort and the LN-negative (pN0) subgroup, a higher LN yield was associated with lower all-cause mortality (multivariable hazard ratio [HR] 0.94 per 5 LNs removed, 95% confidence interval [95% CI] 0.89-1.00 [P = .034] for the entire cohort and HR 0.86, 95% CI 0.79-0.94 [P = .001] for the pN0 subgroup). Among patients with positive LNs (pN+), there was no association noted between LN yield and OS; however, positive and negative LN counts were found to be independent predictors of OS (HR 1.27 per 5 positive LNs, 95% CI 1.16-1.39 [P<.001] and HR 0.90 per 5 negative LNs, 95% CI 0.82-1.00 [P = .049]). CONCLUSIONS: In this large, contemporary cohort of patients with UTUC, LND was found to be used infrequently despite evidence that a higher LN yield is associated with lower all-cause mortality. Cancer 2017;123:1741-1750.
BACKGROUND: Prior studies examining the value of lymph node (LN) dissection (LND) in patients with urothelial carcinoma of the upper urinary tract (UTUC) have produced conflicting results. The objective of the current study was to assess the relationship between 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, 2926 (20%) underwent LND. The median yield was 2 LNs (interquartile range 1-6 LNs). Among the entire cohort and the LN-negative (pN0) subgroup, a higher LN yield was associated with lower all-cause mortality (multivariable hazard ratio [HR] 0.94 per 5 LNs removed, 95% confidence interval [95% CI] 0.89-1.00 [P = .034] for the entire cohort and HR 0.86, 95% CI 0.79-0.94 [P = .001] for the pN0 subgroup). Among patients with positive LNs (pN+), there was no association noted between LN yield and OS; however, positive and negative LN counts were found to be independent predictors of OS (HR 1.27 per 5 positive LNs, 95% CI 1.16-1.39 [P<.001] and HR 0.90 per 5 negative LNs, 95% CI 0.82-1.00 [P = .049]). CONCLUSIONS: In this large, contemporary cohort of patients with UTUC, LND was found to be used infrequently despite evidence that a higher LN yield is associated with lower all-cause mortality. Cancer 2017;123:1741-1750.
Authors: Jeffrey J Leow; William Martin-Doyle; André P Fay; Toni K Choueiri; Steven L Chang; Joaquim Bellmunt Journal: Eur Urol Date: 2014-03-16 Impact factor: 20.096
Authors: Meera R Chappidi; Max Kates; Michael H Johnson; Noah M Hahn; Trinity J Bivalacqua; Phillip M Pierorazio Journal: Urol Oncol Date: 2016-07-27 Impact factor: 3.498
Authors: Thomas Seisen; Benoit Peyronnet; Jose Luis Dominguez-Escrig; Harman M Bruins; Cathy Yuhong Yuan; Marko Babjuk; Andreas Böhle; Maximilian Burger; Eva M Compérat; Nigel C Cowan; Eero Kaasinen; Joan Palou; Bas W G van Rhijn; Richard J Sylvester; Richard Zigeuner; Shahrokh F Shariat; Morgan Rouprêt Journal: Eur Urol Date: 2016-07-28 Impact factor: 20.096
Authors: Christian Bolenz; Shahrokh F Shariat; Mario I Fernández; Vitaly Margulis; Yair Lotan; Pierre Karakiewicz; Mesut Remzi; Eiji Kikuchi; Richard Zigeuner; Alon Weizer; Francesco Montorsi; Karim Bensalah; Christopher G Wood; Marco Roscigno; Cord Langner; Theresa M Koppie; Jay D Raman; Shuji Mikami; Maurice Stephan Michel; Philipp Ströbel Journal: BJU Int Date: 2008-10-16 Impact factor: 5.588
Authors: Matthew R Danzig; Katherine Mallin; James M McKiernan; Walter M Stadler; Srikala S Sridhar; Todd M Morgan; Bernard H Bochner; Cheryl T Lee Journal: Cancer Date: 2018-04-06 Impact factor: 6.860