Prognostic value of extranodal extension and other lymph node parameters in patients with upper tract urothelial carcinoma

Harun Fajkovic; Eugene K. Cha; Claudio Jeldres; Gerhard Donner; Thomas F. Chromecki; Vitaly Margulis; Giacomo Novara; Yair Lotan; Jay D. Raman; Wassim Kassouf; Christian Seitz; Karim Bensalah; Alon Weizer; Eiji Kikuchi; Marco Roscigno; Mesut Remzi; Kazumasa Matsumoto; Eckart Breinl; Armin Pycha; Vincenzo Ficarra; Francesco Montorsi; Pierre I. Karakiewicz; Douglas S. Scherr; Shahrokh F. Shariat

doi:10.1016/j.juro.2011.10.158

Prognostic value of extranodal extension and other lymph node parameters in patients with upper tract urothelial carcinoma

Harun Fajkovic, Eugene K. Cha, Claudio Jeldres, Gerhard Donner, Thomas F. Chromecki, Vitaly Margulis, Giacomo Novara, Yair Lotan, Jay D. Raman, Wassim Kassouf, Christian Seitz, Karim Bensalah, Alon Weizer, Eiji Kikuchi, Marco Roscigno, Mesut Remzi, Kazumasa Matsumoto, Eckart Breinl, Armin Pycha, Vincenzo FicarraFrancesco Montorsi, Pierre I. Karakiewicz, Douglas S. Scherr, Shahrokh F. Shariat

IRCCS Ospedale San Raffaele

Research output: Contribution to journal › Article › peer-review

Abstract

Purpose: We assessed the prognostic value of extranodal extension and other lymph node parameters in a large multicenter cohort of patients with lymph node metastasis after radical nephroureterectomy. Materials and Methods: We retrospectively analyzed the records of 222 patients with lymph node metastasis treated with radical nephroureterectomy for upper tract urothelial carcinoma without neoadjuvant therapy. Each lymph node metastasis was microscopically evaluated for extranodal extension. Results: A median of 4 lymph nodes (IQR 8) was removed. Two lymph nodes (IQR 2) were positive. Lymph node density was 51.3% (IQR 71.7%). Overall 110 patients (49.5%) had extranodal extension, which was associated with more advanced pT stage (p = 0.026). On multivariable analysis extranodal extension was associated with disease recurrence (p = 0.01) and cancer specific mortality (p = 0.013). When stratified by a 30% cutoff, lymph node density was associated with disease recurrence and cancer specific mortality on univariable but not multivariable analysis (p = 0.048 and 0.049, respectively). Adding extranodal extension to a multivariable model including pT stage and tumor architecture improved predictive accuracy for disease recurrence from 70.3% to 74.5% (p

Original language	English
Pages (from-to)	845-851
Number of pages	7
Journal	Journal of Urology
Volume	187
Issue number	3
DOIs	https://doi.org/10.1016/j.juro.2011.10.158
Publication status	Published - Mar 2012

Keywords

carcinoma
lymph node excision
neoplasm metastasis
urinary tract
urothelium

ASJC Scopus subject areas

Urology

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10.1016/j.juro.2011.10.158

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Fajkovic, H., Cha, E. K., Jeldres, C., Donner, G., Chromecki, T. F., Margulis, V., Novara, G., Lotan, Y., Raman, J. D., Kassouf, W., Seitz, C., Bensalah, K., Weizer, A., Kikuchi, E., Roscigno, M., Remzi, M., Matsumoto, K., Breinl, E., Pycha, A., ... Shariat, S. F. (2012). Prognostic value of extranodal extension and other lymph node parameters in patients with upper tract urothelial carcinoma. Journal of Urology, 187(3), 845-851. https://doi.org/10.1016/j.juro.2011.10.158

Fajkovic, H, Cha, EK, Jeldres, C, Donner, G, Chromecki, TF, Margulis, V, Novara, G, Lotan, Y, Raman, JD, Kassouf, W, Seitz, C, Bensalah, K, Weizer, A, Kikuchi, E, Roscigno, M, Remzi, M, Matsumoto, K, Breinl, E, Pycha, A, Ficarra, V, Montorsi, F, Karakiewicz, PI, Scherr, DS & Shariat, SF 2012, 'Prognostic value of extranodal extension and other lymph node parameters in patients with upper tract urothelial carcinoma', Journal of Urology, vol. 187, no. 3, pp. 845-851. https://doi.org/10.1016/j.juro.2011.10.158

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title = "Prognostic value of extranodal extension and other lymph node parameters in patients with upper tract urothelial carcinoma",

abstract = "Purpose: We assessed the prognostic value of extranodal extension and other lymph node parameters in a large multicenter cohort of patients with lymph node metastasis after radical nephroureterectomy. Materials and Methods: We retrospectively analyzed the records of 222 patients with lymph node metastasis treated with radical nephroureterectomy for upper tract urothelial carcinoma without neoadjuvant therapy. Each lymph node metastasis was microscopically evaluated for extranodal extension. Results: A median of 4 lymph nodes (IQR 8) was removed. Two lymph nodes (IQR 2) were positive. Lymph node density was 51.3% (IQR 71.7%). Overall 110 patients (49.5%) had extranodal extension, which was associated with more advanced pT stage (p = 0.026). On multivariable analysis extranodal extension was associated with disease recurrence (p = 0.01) and cancer specific mortality (p = 0.013). When stratified by a 30% cutoff, lymph node density was associated with disease recurrence and cancer specific mortality on univariable but not multivariable analysis (p = 0.048 and 0.049, respectively). Adding extranodal extension to a multivariable model including pT stage and tumor architecture improved predictive accuracy for disease recurrence from 70.3% to 74.5% (p ",

keywords = "carcinoma, lymph node excision, neoplasm metastasis, urinary tract, urothelium",

author = "Harun Fajkovic and Cha, {Eugene K.} and Claudio Jeldres and Gerhard Donner and Chromecki, {Thomas F.} and Vitaly Margulis and Giacomo Novara and Yair Lotan and Raman, {Jay D.} and Wassim Kassouf and Christian Seitz and Karim Bensalah and Alon Weizer and Eiji Kikuchi and Marco Roscigno and Mesut Remzi and Kazumasa Matsumoto and Eckart Breinl and Armin Pycha and Vincenzo Ficarra and Francesco Montorsi and Karakiewicz, {Pierre I.} and Scherr, {Douglas S.} and Shariat, {Shahrokh F.}",

year = "2012",

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doi = "10.1016/j.juro.2011.10.158",

language = "English",

volume = "187",

pages = "845--851",

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T1 - Prognostic value of extranodal extension and other lymph node parameters in patients with upper tract urothelial carcinoma

AU - Fajkovic, Harun

AU - Cha, Eugene K.

AU - Jeldres, Claudio

AU - Donner, Gerhard

AU - Chromecki, Thomas F.

AU - Margulis, Vitaly

AU - Novara, Giacomo

AU - Lotan, Yair

AU - Raman, Jay D.

AU - Kassouf, Wassim

AU - Seitz, Christian

AU - Bensalah, Karim

AU - Weizer, Alon

AU - Kikuchi, Eiji

AU - Roscigno, Marco

AU - Remzi, Mesut

AU - Matsumoto, Kazumasa

AU - Breinl, Eckart

AU - Pycha, Armin

AU - Ficarra, Vincenzo

AU - Montorsi, Francesco

AU - Karakiewicz, Pierre I.

AU - Scherr, Douglas S.

AU - Shariat, Shahrokh F.

PY - 2012/3

Y1 - 2012/3

N2 - Purpose: We assessed the prognostic value of extranodal extension and other lymph node parameters in a large multicenter cohort of patients with lymph node metastasis after radical nephroureterectomy. Materials and Methods: We retrospectively analyzed the records of 222 patients with lymph node metastasis treated with radical nephroureterectomy for upper tract urothelial carcinoma without neoadjuvant therapy. Each lymph node metastasis was microscopically evaluated for extranodal extension. Results: A median of 4 lymph nodes (IQR 8) was removed. Two lymph nodes (IQR 2) were positive. Lymph node density was 51.3% (IQR 71.7%). Overall 110 patients (49.5%) had extranodal extension, which was associated with more advanced pT stage (p = 0.026). On multivariable analysis extranodal extension was associated with disease recurrence (p = 0.01) and cancer specific mortality (p = 0.013). When stratified by a 30% cutoff, lymph node density was associated with disease recurrence and cancer specific mortality on univariable but not multivariable analysis (p = 0.048 and 0.049, respectively). Adding extranodal extension to a multivariable model including pT stage and tumor architecture improved predictive accuracy for disease recurrence from 70.3% to 74.5% (p

AB - Purpose: We assessed the prognostic value of extranodal extension and other lymph node parameters in a large multicenter cohort of patients with lymph node metastasis after radical nephroureterectomy. Materials and Methods: We retrospectively analyzed the records of 222 patients with lymph node metastasis treated with radical nephroureterectomy for upper tract urothelial carcinoma without neoadjuvant therapy. Each lymph node metastasis was microscopically evaluated for extranodal extension. Results: A median of 4 lymph nodes (IQR 8) was removed. Two lymph nodes (IQR 2) were positive. Lymph node density was 51.3% (IQR 71.7%). Overall 110 patients (49.5%) had extranodal extension, which was associated with more advanced pT stage (p = 0.026). On multivariable analysis extranodal extension was associated with disease recurrence (p = 0.01) and cancer specific mortality (p = 0.013). When stratified by a 30% cutoff, lymph node density was associated with disease recurrence and cancer specific mortality on univariable but not multivariable analysis (p = 0.048 and 0.049, respectively). Adding extranodal extension to a multivariable model including pT stage and tumor architecture improved predictive accuracy for disease recurrence from 70.3% to 74.5% (p

KW - carcinoma

KW - lymph node excision

KW - neoplasm metastasis

KW - urinary tract

KW - urothelium

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VL - 187

SP - 845

EP - 851

JO - Journal of Urology

JF - Journal of Urology

SN - 0022-5347

IS - 3

ER -

Prognostic value of extranodal extension and other lymph node parameters in patients with upper tract urothelial carcinoma

Abstract

Keywords

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