Prognostic Value of Lymph Node Dissection in Patients with Muscle-Invasive Transitional Cell Carcinoma of the Upper Urinary Tract

Objectives: To analyze the prognostic role of lymphadenectomy (LND) in patients with muscle-invasive transitional cell carcinoma (TCC) of the upper urinary tract (UUT) managed with radical surgery. Methods: From 1986 to 2003, 132 consecutive patients with muscle-invasive TCC of the UUT underwent radical surgery. LND was performed in 95 cases. Patients were stratified according to the presence of LND and lymph node (LN) status. Univariable and multivariable Cox regression models determined the effect of age, pT, grade, nodal status (pN), number of LNs removed, year of surgery, and postoperative chemotherapy on disease-free survival (DFS) and cancer-specific survival (CSS) in the overall population and in patients who underwent LND. Results: The actuarial 5-yr CSS in pNx patients was significantly worse than in pN0 patients (48% vs. 73%, p = 0.001) and comparable to pN+ outcome (48% vs. 39%, p = 0.476). In the entire population, multivariable Cox regression analyses indicated that pT and pN status were independent predictors of DFS (p = 0.04, hazard ratio [HR] = 1.82 and p <0.01, HR = 1.34, respectively) and CSS (p <0.01, HR = 2.42 and p = 0.04, HR = 1.32, respectively). In patients who underwent LND, the number of LNs removed was an independent predictor of DFS (p = 0.03, HR = 0.928) and of CSS (p = 0.007, HR = 0.903). The extent of LND again resulted in an independent predictor either of DFS or CSS (p = 0.04, HR = 0.904 and p = 0.01, HR = 0.867, respectively) in the subgroup of pN0 patients. Conclusions: LND emerged as a strong independent predictor of DFS and CSS in patients surgically managed for a muscle-invasive TCC of the UUT.