A Critical Appraisal of the Value of Lymph Node Dissection at Nephroureterectomy for Upper Tract Urothelial Carcinoma

Giovanni Lughezzani, Claudio Jeldres, Hendrik Isbarn, Shahrokh F. Shariat, Maxine Sun, Daniel Pharand, Hugues Widmer, Philippe Arjane, Markus Graefen, Francesco Montorsi, Paul Perrotte, Pierre I. Karakiewicz

Research output: Contribution to journalArticlepeer-review

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 languageEnglish
Pages (from-to)118-124
Number of pages7
JournalUrology
Volume75
Issue number1
DOIs
Publication statusPublished - Jan 2010

ASJC Scopus subject areas

  • Urology

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