Junichi Inokuchi1, Kentaro Kuroiwa2, Yoshiyuki Kakehi3, Mikio Sugimoto3, Toshiki Tanigawa4, Hiroyuki Fujimoto5, Momokazu Gotoh6, Naoya Masumori7, Osamu Ogawa8, Masatoshi Eto1, Chikara Ohyama9, Akito Yamaguchi10, Hideyasu Matsuyama11, Tomohiko Ichikawa12, Tomohiko Asano13, Junki Mizusawa14, Junko Eba14, Seiji Naito15,16. 1. Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. 2. Department of Urology, Miyazaki Prefectural Miyazaki Hospital, 5-30 Kitatakamatsu-cho, Miyazaki, 880-8510, Japan. 3. Department of Urology, Faculty of Medicine, Kagawa University, 1750-1 Oaza Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan. 4. Department of Urology, Niigata Cancer Center Hospital, 2-15-3 Kawagishimachi, Chuo-ku, Niigata, 951-8566, Japan. 5. Urology Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. 6. Department of Urology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, 466-8550, Japan. 7. Department of Urology, Sapporo Medical University School of Medicine, S1W16, Chuo-ku, Sapporo, 060-8543, Japan. 8. Department of Urology, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan. 9. Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki, 036-8562, Japan. 10. Department of Urology, Harasanshin Hospital, 1-8 Taihakumachi, Hakata-ku, Fukuoka, 812-0033, Japan. 11. Department of Urology, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minami-kogushi, Ube, Yamaguchi, 755-8505, Japan. 12. Department of Urology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan. 13. Department of Urology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan. 14. JCOG Data Center/Operations Office, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. 15. Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. naito@harasanshin.or.jp. 16. Department of Urology, Harasanshin Hospital, 1-8 Taihakumachi, Hakata-ku, Fukuoka, 812-0033, Japan. naito@harasanshin.or.jp.
Abstract
PURPOSE: To evaluate the impact of lymph node dissection (LND) on clinical outcome during radical nephroureterectomy (RNU) for patients with upper urinary tract urothelial cancer (UTUC). METHODS: We, the Urologic Oncology Study Group of the Japan Clinical Oncology Group (JCOG), retrospectively collected data from patients with non-metastatic UTUC who underwent RNU in 30 centers in 1995-2009. Ineligible patients and patients with previous and/or synchronous bladder cancer were excluded, and the remaining 2037 patients were analyzed. We compared overall and cancer-specific mortality between patients who underwent LND (LND group) and those without LND (no-LND group). RESULTS: Among 2037 patients, LND was performed in 1046 (51.4%) patients, and 223 (10.9%) patients had pathological node-positive (pN+) disease. All-cause mortality was observed in 503 patients (24.7%) during follow-up (median 45.8 months), including 363 patients (17.8%) who died of UTUC. Patients with pN+ disease showed significantly shorter overall survival (OS) compared with pN0 patients, and the estimated 5-year OS for pN+ patients was 30%. Older age, ≥cT3, and clinical node-positive disease were found as preoperative predictors for pN+ disease by multivariate analysis. In the comparison of OS and cancer-specific mortality between LND and no-LND groups, there was no significant improvement by LND in multivariate analysis. The median number of lymph nodes removed was six (IQR 3-11). There was no significant association between the number of lymph nodes removed and OS. CONCLUSIONS: The present study indicates that there is no therapeutic benefit of LND during RNU for UTUC, although pathologically positive LN status can predict poor prognosis.
PURPOSE: To evaluate the impact of lymph node dissection (LND) on clinical outcome during radical nephroureterectomy (RNU) for patients with upper urinary tract urothelial cancer (UTUC). METHODS: We, the Urologic Oncology Study Group of the Japan Clinical Oncology Group (JCOG), retrospectively collected data from patients with non-metastatic UTUC who underwent RNU in 30 centers in 1995-2009. Ineligible patients and patients with previous and/or synchronous bladder cancer were excluded, and the remaining 2037 patients were analyzed. We compared overall and cancer-specific mortality between patients who underwent LND (LND group) and those without LND (no-LND group). RESULTS: Among 2037 patients, LND was performed in 1046 (51.4%) patients, and 223 (10.9%) patients had pathological node-positive (pN+) disease. All-cause mortality was observed in 503 patients (24.7%) during follow-up (median 45.8 months), including 363 patients (17.8%) who died of UTUC. Patients with pN+ disease showed significantly shorter overall survival (OS) compared with pN0 patients, and the estimated 5-year OS for pN+ patients was 30%. Older age, ≥cT3, and clinical node-positive disease were found as preoperative predictors for pN+ disease by multivariate analysis. In the comparison of OS and cancer-specific mortality between LND and no-LND groups, there was no significant improvement by LND in multivariate analysis. The median number of lymph nodes removed was six (IQR 3-11). There was no significant association between the number of lymph nodes removed and OS. CONCLUSIONS: The present study indicates that there is no therapeutic benefit of LND during RNU for UTUC, although pathologically positive LN status can predict poor prognosis.
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: Eugene K Cha; Shahrokh F Shariat; Matthias Kormaksson; Giacomo Novara; Thomas F Chromecki; Douglas S Scherr; Yair Lotan; Jay D Raman; Wassim Kassouf; Richard Zigeuner; Mesut Remzi; Karim Bensalah; Alon Weizer; Eiji Kikuchi; Christian Bolenz; Marco Roscigno; Theresa M Koppie; Casey K Ng; Hans-Martin Fritsche; Kazumasa Matsumoto; Thomas J Walton; Behfar Ehdaie; Stefan Tritschler; Harun Fajkovic; Juan I Martínez-Salamanca; Armin Pycha; Cord Langner; Vincenzo Ficarra; Jean-Jacques Patard; Francesco Montorsi; Christopher G Wood; Pierre I Karakiewicz; Vitaly Margulis Journal: Eur Urol Date: 2012-01-23 Impact factor: 20.096
Authors: Thomas Seisen; Ross E Krasnow; Joaquim Bellmunt; Morgan Rouprêt; Jeffrey J Leow; Stuart R Lipsitz; Malte W Vetterlein; Mark A Preston; Nawar Hanna; Adam S Kibel; Maxine Sun; Toni K Choueiri; Quoc-Dien Trinh; Steven L Chang Journal: J Clin Oncol Date: 2017-01-03 Impact factor: 44.544
Authors: Maximilian Burger; Shahrokh F Shariat; Hans-Martin Fritsche; Juan Ignacio Martinez-Salamanca; Kazumasa Matsumoto; Thomas F Chromecki; Vincenzo Ficarra; Wassim Kassouf; Christian Seitz; Armin Pycha; Stefan Tritschler; Thomas J Walton; Giacomo Novara Journal: World J Urol Date: 2011-06-01 Impact factor: 4.226
Authors: Ross J Mason; Wassim Kassouf; David G Bell; Louis Lacombe; Anil Kapoor; Niels Jacobsen; Adrian Fairey; Jonathan Izawa; Peter Black; Simon Tanguay; Joseph Chin; Alan So; Jean-Baptiste Lattouf; Fred Saad; Edward Matsumoto; Darrel Drachenberg; Ilias Cagiannos; Yves Fradet; Ricardo A Rendon Journal: Urology Date: 2012-02-25 Impact factor: 2.649
Authors: Andrew G Winer; Emily A Vertosick; Mazyar Ghanaat; Renato B Corradi; Sigrid Carlsson; Daniel D Sjoberg; Alexander I Sankin; John P Sfakianos; Eugene K Cha; Guido Dalbagni; Jonathan A Coleman Journal: Urol Oncol Date: 2016-12-05 Impact factor: 3.498
Authors: Adil Ouzzane; Pierre Colin; Tarek P Ghoneim; Marc Zerbib; Alexandre De La Taille; François Audenet; Fabien Saint; Nicolas Hoarau; Emilie Adam; Marie Dominique Azemar; Henri Bensadoun; Luc Cormier; Olivier Cussenot; Alain Houlgatte; Gilles Karsenty; Charlotte Maurin; François Xavier Nouhaud; Véronique Phe; Thomas Polguer; Mathieu Roumiguié; Alain Ruffion; Morgan Rouprêt Journal: World J Urol Date: 2012-12-11 Impact factor: 4.226
Authors: Bjarte Almås; Stein Øverby; Ole J Halvorsen; Lars A R Reisæter; Jørg Assmus; Birgitte Carlsen; Anders Loe; Christian Beisland Journal: World J Urol Date: 2019-05-23 Impact factor: 4.226
Authors: Florestan J Koll; Eva Meisenzahl; Bernhard Haller; Philipp Maisch; Florian Kirchhoff; Thomas Horn; Jürgen E Gschwend; Sebastian C Schmid Journal: Front Surg Date: 2021-11-25
Authors: Arthur Peyrottes; Gianluigi Califano; Idir Ouzaïd; Paul Lainé-Caroff; Thibaut Long Depaquit; Jean-François Hermieu; Evanguelos Xylinas Journal: Front Surg Date: 2022-03-24