Sebastiano Nazzani1, Elio Mazzone2, Felix Preisser3, Zhe Tian4, Francesco A Mistretta5, Shahrokh F Shariat6, Emanuele Montanari7, Pietro Acquati8, Alberto Briganti9, Fred Saad10, Luca Carmignani8, Pierre I Karakiewicz10. 1. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal, Montréal, Québec, Canada; Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy. Electronic address: sebastiano.nazzani@yahoo.com. 2. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal, Montréal, Québec, Canada; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy Vita-Salute San Raffaele University, Milan, Italy. 3. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal, Montréal, Québec, Canada; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 4. Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal, Montréal, Québec, Canada. 5. Department of Urology, Istituto Europeo di Oncologia, Milan, Italy. 6. Department of Urology, Medical University of Vienna, Vienna, Austria. 7. Department of Urology, IRCCS Fondazione Ca' Granda-Ospedale Maggiore Policlinico University of Milan, Milan, Italy. 8. Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy. 9. Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy Vita-Salute San Raffaele University, Milan, Italy. 10. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal, Montréal, Québec, Canada.
Abstract
PURPOSE: To analyze lymph node invasion (LNI) rates according to tumor characteristics and to test the impact of LNI and its extent on cancer specific mortality (CSM) in surgically-treated non metastatic urothelial upper urinary tract carcinoma (UTUC) patients. MATERIALS AND METHODS: Within the SEER database (2004-2014), we identified 2098 patients with histologically confirmed non-metastatic urothelial carcinoma of renal pelvis or ureter who underwent NU with LND. LNI rates stratified according to tumor location and stage were described. Kaplan-Meier plots illustrated CSM rates according to LNI and its extent. Multivariable Cox regression models (MCRMs) tested the effect of LNI and its extent on CSM. RESULTS: Of 2098 UTUC patients, who underwent nephroureterectomy with lymph node dissection, 646 (33%) had LNI. The median number of removed lymph nodes was 3 [Interquartile range (IQR): 1-7]. The median number of positive lymph nodes in patients, who harbored LNI was 1 (IQR:1-3). LNI rates according to tumor location were, respectively, 23.6% for ureteral and 36.5% for renal pelvis tumors. LNI rates according to tumor stage were 9.6, 18.0, 38.7 and 63.9%, for respectively, T1, T2, T3 and T4 UTUC. In MCRMs, LNI achieved independent predictor status for higher CSM (HR 3.00; p < 0.001). Finally, in MCRMs, number of positive lymph nodes defined as the 75th percentile (n ≥ 3) achieved independent predictor status for higher CSM (HR 1.37; p = 0.04). CONCLUSIONS: LNI in non-metastatic UTUC patients is the most important determinant of CSM. Number of positive lymph node is independently associated with higher CSM. In consequence, lymph node dissection can provide extensive prognostic information.
PURPOSE: To analyze lymph node invasion (LNI) rates according to tumor characteristics and to test the impact of LNI and its extent on cancer specific mortality (CSM) in surgically-treated non metastatic urothelial upper urinary tract carcinoma (UTUC) patients. MATERIALS AND METHODS: Within the SEER database (2004-2014), we identified 2098 patients with histologically confirmed non-metastatic urothelial carcinoma of renal pelvis or ureter who underwent NU with LND. LNI rates stratified according to tumor location and stage were described. Kaplan-Meier plots illustrated CSM rates according to LNI and its extent. Multivariable Cox regression models (MCRMs) tested the effect of LNI and its extent on CSM. RESULTS: Of 2098 UTUC patients, who underwent nephroureterectomy with lymph node dissection, 646 (33%) had LNI. The median number of removed lymph nodes was 3 [Interquartile range (IQR): 1-7]. The median number of positive lymph nodes in patients, who harbored LNI was 1 (IQR:1-3). LNI rates according to tumor location were, respectively, 23.6% for ureteral and 36.5% for renal pelvis tumors. LNI rates according to tumor stage were 9.6, 18.0, 38.7 and 63.9%, for respectively, T1, T2, T3 and T4 UTUC. In MCRMs, LNI achieved independent predictor status for higher CSM (HR 3.00; p < 0.001). Finally, in MCRMs, number of positive lymph nodes defined as the 75th percentile (n ≥ 3) achieved independent predictor status for higher CSM (HR 1.37; p = 0.04). CONCLUSIONS: LNI in non-metastatic UTUC patients is the most important determinant of CSM. Number of positive lymph node is independently associated with higher CSM. In consequence, lymph node dissection can provide extensive prognostic information.
Authors: Baris Turkbey; Marcin Czarniecki; Joanna H Shih; Stephanie A Harmon; Piyush K Agarwal; Andrea B Apolo; Deborah E Citrin; James L Gulley; Mukesh Harisinghani; Ravi A Madan; Adam R Metwalli; Edmond Paquette; Peter A Pinto; Soroush Rais-Bahrami; Lindsay S Rowe; Bradford J Wood; Paula M Jacobs; Liza Lindenberg; William Dahut; Peter L Choyke Journal: AJR Am J Roentgenol Date: 2019-10-15 Impact factor: 3.959