Abstract
Objectives: To perform a population-based analysis of the potential staging or prognostic value (or both) of lymph node dissection (LND) in patients without nodal metastases vs no LND. In several previous reports, LND in patients with upper tract urothelial carcinoma (UTUC) treated with nephroureterectomy (NU) was associated with better survival relative to no LND (pNx), even in the absence of pathologically confirmed nodal metastases (pN0). Methods: Within the surveillance, epidemiology, and end results database, we identified 2824 patients treated with NU for UTUC between 1988 and 2004. CSM rates after NU were graphically explored using Kaplan-Meier plots. Univariable and multivariable Cox regression models tested the effect of N0 vs Nx stage on CSM, after adjusting for T stage, tumor grade, age, gender, primary tumor location, type, and year of surgery. Results: The CSM-free survival rate at 5 years after NU was 81.2% and 77.8% respectively for pN0 and pNx patients. In univariable analyses pNx vs pN0 status was not associated with worse survival (HR: 1.19; P = .09). After adjustment for all covariates, pNx vs pN0 status still failed to achieve independent predictor status (HR: 0.99; P = .9). Conclusions: We found no survival benefit related to the performance of LND in pN0 patients, relative to pNx patients. Lack of standardized criteria for patients' selection for LND and for pathological lymph node specimen evaluation represents some of the explanation for the observed discrepancy between the current finding and previous findings. Crown
| Original language | English |
|---|---|
| Pages (from-to) | 118-124 |
| Number of pages | 7 |
| Journal | Urology |
| Volume | 75 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Jan 2010 |
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ASJC Scopus subject areas
- Urology
Cite this
A Critical Appraisal of the Value of Lymph Node Dissection at Nephroureterectomy for Upper Tract Urothelial Carcinoma. / Lughezzani, Giovanni; Jeldres, Claudio; Isbarn, Hendrik; Shariat, Shahrokh F.; Sun, Maxine; Pharand, Daniel; Widmer, Hugues; Arjane, Philippe; Graefen, Markus; Montorsi, Francesco; Perrotte, Paul; Karakiewicz, Pierre I.
In: Urology, Vol. 75, No. 1, 01.2010, p. 118-124.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - A Critical Appraisal of the Value of Lymph Node Dissection at Nephroureterectomy for Upper Tract Urothelial Carcinoma
AU - Lughezzani, Giovanni
AU - Jeldres, Claudio
AU - Isbarn, Hendrik
AU - Shariat, Shahrokh F.
AU - Sun, Maxine
AU - Pharand, Daniel
AU - Widmer, Hugues
AU - Arjane, Philippe
AU - Graefen, Markus
AU - Montorsi, Francesco
AU - Perrotte, Paul
AU - Karakiewicz, Pierre I.
PY - 2010/1
Y1 - 2010/1
N2 - Objectives: To perform a population-based analysis of the potential staging or prognostic value (or both) of lymph node dissection (LND) in patients without nodal metastases vs no LND. In several previous reports, LND in patients with upper tract urothelial carcinoma (UTUC) treated with nephroureterectomy (NU) was associated with better survival relative to no LND (pNx), even in the absence of pathologically confirmed nodal metastases (pN0). Methods: Within the surveillance, epidemiology, and end results database, we identified 2824 patients treated with NU for UTUC between 1988 and 2004. CSM rates after NU were graphically explored using Kaplan-Meier plots. Univariable and multivariable Cox regression models tested the effect of N0 vs Nx stage on CSM, after adjusting for T stage, tumor grade, age, gender, primary tumor location, type, and year of surgery. Results: The CSM-free survival rate at 5 years after NU was 81.2% and 77.8% respectively for pN0 and pNx patients. In univariable analyses pNx vs pN0 status was not associated with worse survival (HR: 1.19; P = .09). After adjustment for all covariates, pNx vs pN0 status still failed to achieve independent predictor status (HR: 0.99; P = .9). Conclusions: We found no survival benefit related to the performance of LND in pN0 patients, relative to pNx patients. Lack of standardized criteria for patients' selection for LND and for pathological lymph node specimen evaluation represents some of the explanation for the observed discrepancy between the current finding and previous findings. Crown
AB - Objectives: To perform a population-based analysis of the potential staging or prognostic value (or both) of lymph node dissection (LND) in patients without nodal metastases vs no LND. In several previous reports, LND in patients with upper tract urothelial carcinoma (UTUC) treated with nephroureterectomy (NU) was associated with better survival relative to no LND (pNx), even in the absence of pathologically confirmed nodal metastases (pN0). Methods: Within the surveillance, epidemiology, and end results database, we identified 2824 patients treated with NU for UTUC between 1988 and 2004. CSM rates after NU were graphically explored using Kaplan-Meier plots. Univariable and multivariable Cox regression models tested the effect of N0 vs Nx stage on CSM, after adjusting for T stage, tumor grade, age, gender, primary tumor location, type, and year of surgery. Results: The CSM-free survival rate at 5 years after NU was 81.2% and 77.8% respectively for pN0 and pNx patients. In univariable analyses pNx vs pN0 status was not associated with worse survival (HR: 1.19; P = .09). After adjustment for all covariates, pNx vs pN0 status still failed to achieve independent predictor status (HR: 0.99; P = .9). Conclusions: We found no survival benefit related to the performance of LND in pN0 patients, relative to pNx patients. Lack of standardized criteria for patients' selection for LND and for pathological lymph node specimen evaluation represents some of the explanation for the observed discrepancy between the current finding and previous findings. Crown
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U2 - 10.1016/j.urology.2009.07.1296
DO - 10.1016/j.urology.2009.07.1296
M3 - Article
C2 - 19864000
AN - SCOPUS:72249118659
VL - 75
SP - 118
EP - 124
JO - Urology
JF - Urology
SN - 0090-4295
IS - 1
ER -