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Meireles S, Dias N, Martins D, Dias C, Gonçalves M, Silva J, Silva CM, Oliveira PD, Soares P, Lopes JM. Prognostic Value of Bladder Involvement in the Outcome of Upper Tract Urothelial Carcinoma. Diagnostics (Basel) 2023; 13:diagnostics13010153. [PMID: 36611446 PMCID: PMC9818601 DOI: 10.3390/diagnostics13010153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023] Open
Abstract
Accurately predicting the clinical prognosis of upper tract urothelial carcinoma (UTUC) seems crucial. We evaluated the effect of the involvement of urothelial bladder carcinoma (UBC) as a potential prognostic factor for overall survival (OS) and progression-free survival (PFS). The cohort included 115 patients with UTUC, subgrouped between January 2009 and December 2019 as follows: (1) only UTUC and (2) UTUC with synchronous or metachronous UBC (UTUC + UBC). Univariate and multivariate analyses were performed to identify independent prognostic factors for OS and PFS. Synchronous or metachronous UBC diagnosis in UTUC patients was an independent predictor of worse PFS (HR 3.326 CI 95% 1.474−7.503, p = 0.004), but it was not identified as a prognostic factor for OS (p > 0.05). Lymphovascular invasion (LVI) was associated with decreased PFS (HR 2.687 CI 95%1.172−6.163, p = 0.020) and OS (HR 4.980 CI 95%1.763−14.064, p = 0.002). This study indicates that concomitant or later UBC could predict a poor PFS, but it is not associated with a significantly worse OS in UTUC patients. The prognostic impact of LVI underlines its inclusion in the tumor staging system of UTUC.
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Affiliation(s)
- Sara Meireles
- Institute for Research and Innovation in Health (i3S), University of Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal
- Institute of Molecular Pathology, Immunology of the University of Porto (IPATIMUP), Rua Júlio Amaral de Carvalho 45, 4200-135 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Medical Oncology Department, Centro Hospitalar Universitário de São João (CHUSJ), Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Correspondence: ; Tel.: +351-961313435
| | - Nuno Dias
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Urology Department, Centro Hospitalar Universitário de São João (CHUSJ), Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Diana Martins
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Pathology Department, Centro Hospitalar Universitário de São João (CHUSJ), Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Carolina Dias
- Institute for Research and Innovation in Health (i3S), University of Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal
- Institute of Molecular Pathology, Immunology of the University of Porto (IPATIMUP), Rua Júlio Amaral de Carvalho 45, 4200-135 Porto, Portugal
| | - Marina Gonçalves
- Medical Oncology Department, Centro Hospitalar Universitário de São João (CHUSJ), Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - João Silva
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Urology Department, Centro Hospitalar Universitário de São João (CHUSJ), Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Carlos Martins Silva
- Institute for Research and Innovation in Health (i3S), University of Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Urology Department, Centro Hospitalar Universitário de São João (CHUSJ), Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Paulo Dinis Oliveira
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Urology Department, Centro Hospitalar Universitário de São João (CHUSJ), Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Paula Soares
- Institute for Research and Innovation in Health (i3S), University of Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal
- Institute of Molecular Pathology, Immunology of the University of Porto (IPATIMUP), Rua Júlio Amaral de Carvalho 45, 4200-135 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - José Manuel Lopes
- Institute for Research and Innovation in Health (i3S), University of Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal
- Institute of Molecular Pathology, Immunology of the University of Porto (IPATIMUP), Rua Júlio Amaral de Carvalho 45, 4200-135 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Pathology Department, Centro Hospitalar Universitário de São João (CHUSJ), Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
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Hsieh HC, Wang CL, Chen CS, Yang CK, Li JR, Wang SS, Cheng CL, Lin CY, Chiu KY. The prognostic impact of lymph node dissection for clinically node-negative upper urinary tract urothelial carcinoma in patients who are treated with radical nephroureterectomy. PLoS One 2022; 17:e0278038. [PMID: 36454803 PMCID: PMC9714942 DOI: 10.1371/journal.pone.0278038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/08/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND To evaluate the prognostic impact of lymph node dissection (LND) in patients who underwent radical nephroureterectomy (RNU) with bladder cuff excision (BCE) for clinically node-negative (cN0) upper urinary tract urothelial carcinoma (UTUC). METHODS We retrospectively enrolled 520 patients with cN0 UTUC in a single tertiary referral center from 2000 to 2015. The patients were divided into three groups: patients with and without pathologically proved lymph node metastasis (pN1-3 and pN0, respectively) and patients without LND (pNx). We analyzed associations between overall survival (OS)/ disease-free survival (DFS)/ cancer-specific survival (CSS) and clinical characteristics. RESULTS The patients were divided into three groups (pN1-3, pN0 and pNx with 20, 303, and 197 patients, respectively). OS/DFS/CSS in the pN1-3 group were significantly worse (all p<0.001) compared with the pN0 group. However, there were no significant differences between the pNx and pN0 groups. In the multivariate analyses, CSS was only affected by age [(hazard ratio (HR) = 1.03, p = 0.008]), positive surgical margin (HR = 3.38, p<0.001) and pathological T3-4 stages (HR = 4.07, p<0.001). In the subgroup analyses for patients with LND, locally advanced disease (pT3 and pT4) had significantly more metastases [T3-4: 13.91% (16/115) vs. T0-2: 1.92% (4/208), p<0.001]. CONCLUSIONS In the pN0 group, LND for cN0 UTUC did not show therapeutic benefits in terms of DFS, CSS, and OS. However, LND with RNU allowed optimal tumor staging, through patients still had a poor prognosis. Clinically occult LN metastases were found in 6.2% of our patients.
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Affiliation(s)
- Hsiang-Chen Hsieh
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chun-Li Wang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chuan-Shu Chen
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Cheng-Kuang Yang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jian-Ri Li
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medicine and Nursing, Hungkuang University, Taichung, Taiwan
| | - Shian-Shiang Wang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medicine and Nursing, Hungkuang University, Taichung, Taiwan
| | - Chen-Li Cheng
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chia-Yen Lin
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- * E-mail: (CYL); (KYC)
| | - Kun-Yuan Chiu
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Applied Chemistry, National Chi Nan University, Nantou, Taiwan
- * E-mail: (CYL); (KYC)
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Xia HR, Li SG, Zhai XQ, Liu M, Guo XX, Wang JY. The Value of Lymph Node Dissection in Patients With Node-Positive Upper Urinary Tract Urothelial Cancer: A Retrospective Cohort Study. Front Oncol 2022; 12:889144. [PMID: 35785156 PMCID: PMC9245452 DOI: 10.3389/fonc.2022.889144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeThe value of lymphadenectomy during radical nephroureterectomy (RNU) remains unclear. This study aimed to determine the effects of the removed lymph node (RLN) counts, positive lymph node (pLN) counts, and pLN density (pLND) on survival outcomes in patients with node-positive upper urinary tract urothelial cancer (UTUC).MethodsA total of 306 patients with node-positive UTUC in the Surveillance, Epidemiology, and End Results database between 2004 and 2016 were identified. Multivariable Cox regression analyses were used to evaluate the effect of RLN counts, pLN counts, and pLND on survival outcomes. The maximally selected rank statistics were used to determine the most informative cutoff value for pLND on survival outcomes.ResultsThe RLN counts or pLN counts were not associated with survival outcomes, whereas higher pLND was associated with lower cancer-specific survival (CSS) and overall survival (OS) [hazard ratio (HR) 1.75, P = 0.014 and HR 1.62, P = 0.036, respectively]. The most informative cutoff value for pLND in relation to survival was 27%. Patients with pLND ≥27% had worse 5-year survival rates than those with pLND <27% (52.9% vs. 75.9% for CSS and 18.7% vs. 34.2% for OS, each P < 0.05). Furthermore, the multivariable Cox regression model with pLND could predict 5-year CSS (AUC 0.732 vs. 0.647) or OS (AUC 0.704 vs. 0.621) more accurately than the model without pLND.ConclusionsFor patients with node-positive UTUC, more lymph nodes removed do not offer a better therapeutic effect. However, pLND provides additional prognostic value.
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Affiliation(s)
- Hao-ran Xia
- Department of urology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Shu-guang Li
- Department of Urology, Zoucheng People`s Hospital, Zoucheng, China
| | - Xing-quan Zhai
- Department of Urology, Zoucheng People`s Hospital, Zoucheng, China
| | - Min Liu
- Department of urology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Xiao-xiao Guo
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- *Correspondence: Jian-ye Wang, ; Xiao-xiao Guo,
| | - Jian-ye Wang
- Department of urology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
- *Correspondence: Jian-ye Wang, ; Xiao-xiao Guo,
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Peyrottes A, Califano G, Ouzaïd I, Lainé-Caroff P, Long Depaquit T, Hermieu JF, Xylinas E. Lymph Node Dissection During Radical Nephro-Ureterectomy for Upper Tract Urothelial Carcinoma: A Review. Front Surg 2022; 9:852969. [PMID: 35402485 PMCID: PMC8987284 DOI: 10.3389/fsurg.2022.852969] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/08/2022] [Indexed: 02/03/2023] Open
Abstract
Although lymphonodal dissection is well-accepted for muscle-invasive bladder cancer management, its role is still debated during radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). The aim of this study was to summarize the current knowledge concerning the indication, anatomical template, prognostic, and therapeutic roles of lymph node dissection (LND) performed at the time of RNU. Quality control markers, such as the number of lymph nodes (LN) removed, lymph node density, and safety of the different surgical approaches, were assessed. We performed a narrative review using the PubMed and ClinicalTrials.gov databases. We identified and analyzed articles based on the practice and the role of lymph node dissection for non-metastatic UTUC. There are no clear guidelines regarding the indication of LND for UTUC, but aggressive tumors may beneficiate from lymphadenectomy since lymph node invasion is a clear independent poor prognostic factor, allowing for adjuvant treatments. It seems that an extended lymphadenectomy may provide therapeutic advantages as a higher number of nodes removed may be related to the removal of undetected LNs micrometastases and a subsequent improvement in recurrence rate and cancer-specific survival. Clear anatomical templates are thus needed based on the location and the laterality of the primary tumor.
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Affiliation(s)
- Arthur Peyrottes
- Department of Urology, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris University, Paris, France
| | - Gianluigi Califano
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Idir Ouzaïd
- Department of Urology, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris University, Paris, France
| | - Paul Lainé-Caroff
- Department of Urology, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris University, Paris, France
| | - Thibaut Long Depaquit
- Urology Unit, Military Teaching Hospital Sainte Anne, French Military Health Service, Toulon, France
| | - Jean-François Hermieu
- Department of Urology, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris University, Paris, France
| | - Evanguelos Xylinas
- Department of Urology, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris University, Paris, France
- *Correspondence: Evanguelos Xylinas
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McIntosh AG, Umbreit EC, Wood CG, Matin SF, Karam JA. Role of lymph node dissection at the time of open or minimally invasive nephroureterectomy. Transl Androl Urol 2021; 10:2233-2245. [PMID: 34159106 PMCID: PMC8185683 DOI: 10.21037/tau.2019.11.34] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Unlike urothelial carcinoma of the bladder, there is no guideline-based consensus on whether a lymph node dissection (LND) should be performed at the time of radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Variable lymphatic drainage based on primary tumor location, lack of prospective trials, and difficulties in developing a risk-adapted approach to LND for UTUC are all challenges to the development of an established approach. The UTUC literature consists of an evidence pool that has historically been limited to single-institution series with heterogenous inclusion criteria for LND and variable LND templates. Areas of controversy exist regarding migration to the great vessel LN beds for mid and distal tumors. A lack of template standardization limits the interpretation of studies relative to one another and a lack of uniformity in reporting templates may lead to inaccuracies in the estimation of lymph node metastasis landing sites. Most clinicians agree that there is a staging benefit to LND for UTUC. Although the data is somewhat heterogenous, it demonstrates a prognostic and staging benefit to LND in higher stages of UTUC. Unlike the staging benefits provided by LND for UTUC, the therapeutic benefits are not as clearly established. Several studies have evaluated differences in cancer-specific survival (CSS) and demonstrated LND to be an independent predictor of CSS when compared to patients not undergoing LND. However, this finding is not consistent across all studies and the literature is again limited by inclusion heterogeneity and inconsistent or lack or template-based resections. LND for UTUC at the time of RNU is a safe and feasible procedure that seems to especially benefit patients with muscle-invasive or locally advanced disease. Prospective, randomized studies with strict inclusion criteria and defined anatomic templates are needed to definitely characterize the role of LND for UTUC.
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Affiliation(s)
- Andrew G McIntosh
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eric C Umbreit
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christopher G Wood
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Surena F Matin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jose A Karam
- Department of Urology and Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Barton GJ, Tan WP, Inman BA. The nephroureterectomy: a review of technique and current controversies. Transl Androl Urol 2020; 9:3168-3190. [PMID: 33457289 PMCID: PMC7807352 DOI: 10.21037/tau.2019.12.07] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The nephroureterectomy (NU) is the standard of care for invasive upper tract urothelial carcinoma (UTUC) and has been around for well over one hundred years. Since then new operative techniques have emerged, new technologies have developed, and the surgery continues to evolve and grow. In this article, we review the various surgical techniques, as well as present the literature surrounding current areas of debate surrounding the NU, including the lymphatic drainage of the upper urinary tract, management of UTUC involvement with the adrenals and caval thrombi, surgical management of the distal ureter, the use of intravesical chemotherapy as well as perioperative systemic chemotherapy, as well as various outcome measures. Although much has been studied about the NU, there still is a dearth of level 1 evidence and the field would benefit from further studies.
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Affiliation(s)
- Gregory J Barton
- Division of Urology, Duke University Medical Center, Durham, NC, USA
| | - Wei Phin Tan
- Division of Urology, Duke University Medical Center, Durham, NC, USA
| | - Brant A Inman
- Division of Urology, Duke University Medical Center, Durham, NC, USA.,Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
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Miki J, Yanagisawa T, Iwatani K, Obayashi K, Fukuokaya W, Mori K, Urabe F, Tsuzuki S, Kimura S, Kimura T, Egawa S. Supine extraperitoneal laparoscopic nephroureterectomy without patient repositioning. Int J Urol 2020; 28:163-168. [PMID: 33197988 DOI: 10.1111/iju.14415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 09/30/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe a novel technique allowing laparoscopic nephroureterectomy with bladder cuff excision and lymphadenectomy, in a complete supine position, without patient repositioning. METHODS Between January 2016 and October 2018, 20 consecutive patients with upper urinary tract urothelial carcinoma underwent supine extraperitoneal laparoscopic nephroureterectomy. The patients were placed in the complete supine position. A 4-cm pararectal skin incision was made and the extraperitoneal space was developed. We used a unique port placement that permits complete access for nephroureterectomy, bladder cuff excision and concomitant lymphadenectomy. Operative parameters and pathological data were analyzed. RESULTS The median age was 70 years (range 49-88 years), the mean operative time was 234 min (range 175-293 min) and the mean estimated blood loss was 67 mL (range 50-200 mL). There were no intraoperative complications, and no patients required transfusion or open conversion. The median number of removed lymph nodes was 10; only one patient had node metastasis. The total operative time and time for nephroureterectomy were significantly longer in the first 10 patients (first group) than in the second 10 patients (second group). Times required for bladder cuff excision and lymphadenectomy did not differ between the two groups. CONCLUSIONS Our novel technique, which enables completion of the entire procedure of nephrouretectomy with bladder cuff excision and lymphadenectomy in the supine position without patient repositioning, is safe and minimizes operative time while maintaining oncological efficacy. We believe this approach might become a standard option for patients with upper urinary tract urothelial carcinoma.
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Affiliation(s)
- Jun Miki
- Department of Urology, Kashiwa Hospital, The Jikei University School of Medicine, Chiba, Japan
| | - Takafumi Yanagisawa
- Department of Urology, Kashiwa Hospital, The Jikei University School of Medicine, Chiba, Japan
| | - Kosuke Iwatani
- Department of Urology, Kashiwa Hospital, The Jikei University School of Medicine, Chiba, Japan
| | - Koki Obayashi
- Department of Urology, Kashiwa Hospital, The Jikei University School of Medicine, Chiba, Japan
| | - Wataru Fukuokaya
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Keiichiro Mori
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Fumihiko Urabe
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shunsuke Tsuzuki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shoji Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shin Egawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
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Data Set for the Reporting of Carcinoma of the Renal Pelvis and Ureter—Nephroureterectomy and Ureterectomy Specimens. Am J Surg Pathol 2019; 43:e1-e12. [DOI: 10.1097/pas.0000000000001305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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9
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Grimes N, McKay A, Lee SM, Aboumarzouk OM. Lymph node dissection during nephroureterectomy: Establishing the existing evidence based on a review of the literature. Arab J Urol 2019; 17:167-180. [PMID: 31489232 PMCID: PMC6711077 DOI: 10.1080/2090598x.2019.1596401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 02/18/2019] [Accepted: 02/26/2019] [Indexed: 12/14/2022] Open
Abstract
Abstract Objective: To determine the role of lymph node dissection (LND) in the treatment of upper tract transitional cell carcinoma (UTTCC), as the role of LND along with nephroureterectomy in treating UTTCC is unclear and several retrospective studies have been published on this topic with conflicting results. Methods: The Medical Literature Analysis and Retrieval System Online (MEDLINE), the Excerpta Medica dataBASE (EMBASE), Cochrane Central Register of Controlled Trials database (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Clinicaltrials.gov, Google Scholar, and individual urological journals, were searched for all studies investigating the role of LND in the treatment of UTTCC. Of the studies identified, those that met inclusion criteria were included in this review. Results: In all, 27 studies were included in this review, with 9303 patients who underwent LND. No randomised controlled trials (RCTs) were identified. Tumours were located in the renal pelvis in 62% of patients, in the ureter in 35.5%, and multifocal in 2.3%. In total: 77.1% were LN-negative and 22.9% had LN metastasis. For all patients undergoing LND, the 5-year recurrence-free survival (RFS) and cancer-specific survival (CSS) rates were 27–65.4% and 32.3–95%, respectively. For patients who underwent a LND in accordance with a standardised anatomical template, the 5-year RFS and CSS rates were 84.3–93% and 83.5–94%, respectively. Conclusion: LND may provide a survival benefit in patients undergoing nephroureterectomy for UTTCC, particularly if following a standardised anatomical template and in those patients with muscle-invasive disease; however, a prospective RCT is required to confirm this. Abbreviations: CSS: cancer-specific survival; LN(D): lymph node (dissection); MeSH: Medical Subject Headings; OS: overall survival; pT: pathological T stage; RCT: randomised controlled trial; RFS: recurrence-free survival; UTTCC: upper tract TCC
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Affiliation(s)
- Nathan Grimes
- Department of Urology, Monklands Hospital, Airdrie, UK
| | - Alastair McKay
- Department of Urology, Glasgow Royal Infirmary, Glasgow, UK
| | - Su-Min Lee
- Department of Urology, Weston Area Health NHS Trust, Weston-super-Mare, UK
| | - Omar M Aboumarzouk
- Department of Urology, Queen Elizabeth University Hospital, Glasgow, UK.,University of Glasgow, Glasgow, UK
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10
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Duquesne I, Ouzaid I, Loriot Y, Moschini M, Xylinas E. Lymphadenectomy for Upper Tract Urothelial Carcinoma: A Systematic Review. J Clin Med 2019; 8:jcm8081190. [PMID: 31398895 PMCID: PMC6722659 DOI: 10.3390/jcm8081190] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/15/2019] [Accepted: 08/05/2019] [Indexed: 12/20/2022] Open
Abstract
Background: The role of lymphonodal dissection during surgery for a tumor of the urinary tract remains controversial. Objective: To analyze anatomical bases of lymphonodal dissection in tumors of the upper urinary tract and analyze its impact on survival, recurrence, and staging. Acquisition of data: A web-based search for scientific articles using Medline/Pubmed was carried out to identify and analyze articles on the practice and the role of lymphonodal dissection in this indication. Data Synthesis: The lymphatic drainage of the upper urinary tract has rarely been studied and is poorly understood. The lymphonodal metastatic extension is the most common extension in upper urinary tract urothelial carcinoma. Lymphnode invasion is a clear independent poor prognostic factor. Therefore, it seems legitimate to offer an extended lymphonodal dissection to patients undergoing surgery to cure these tumors. When lymphnodes dissection respects clear anatomical principles based on the location of the primary tumor and its extension, it improves both survival and recurrence rates. This result could be secondary to the treatment of subclinical metastatic disease. Conclusion: An extended lymphadenectomy during surgery for upper urinary tract urothelial carcinoma following strict anatomical pattern improves staging with a highly probable therapeutic benefit.
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Affiliation(s)
- Igor Duquesne
- Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, 75014 Paris, France
- Department of Cancer Medicine, Gustave Roussy Institute, Cancer Campus, Grand Paris, University of Paris-Sud, 94800 Villejuif, France
| | - Idir Ouzaid
- Department of Urology, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris Diderot University, 75018 Paris, France
| | - Yohann Loriot
- Department of Cancer Medicine, Gustave Roussy Institute, Cancer Campus, Grand Paris, University of Paris-Sud, 94800 Villejuif, France
| | - Marco Moschini
- Klinik für Urologie, Luzerner Kantonsspital, 6004 Lucerne, Switzerland
| | - Evanguelos Xylinas
- Department of Urology, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, 75006 Paris, France.
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EKMEKCİ S, KÜÇÜK Ü, DERE Y, ÇAKIR E, SAYAR HC, ERGANİ B, ÇAKMAK Ö, BOZKURT O, YÖRÜKOĞLU K. 8-armed octopus: Evaluation of clinicopathologic prognostic factors of urothelial carcinoma of the upper urinary system. Turk J Med Sci 2019; 49:153-161. [PMID: 30764592 PMCID: PMC7350879 DOI: 10.3906/sag-1805-51] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background/aim This study was designed to determine the characteristic features of upper urinary system urothelial carcinomas (UUSUCs) and to evaluate the clinicopathological parameters associated with prognosis. Materials and methods A total of 74 cases of UUSUC were included, from three different centers. Demographic data and histopathological features such as tumor localization, concomitant tumor in the urinary system, distant metastasis with overall survival and disease-free survival obtained from the hospital records were evaluated retrospectively. Histopathologic prognostic features such as grade, perineural invasion, lymphovascular invasion, tumor necrosis, and surgical margin status were also evaluated. Results Seventy cases (94.6%) underwent open nephroureterectomy whereas 4 cases (5.4%) had laparoscopic nefroureterectomy. Thirty-eight (51.4%) cases were located in the pelvis, 7 (9.5%) in the ureter, 29 (39.2%) both in the pelvis and ureter. Fifty-six (75.7%) cases were alive; however, 18 (24.3%) patients were found to be dead. pTa, pT1, pT2, pT3, and pT4 tumors were reported in 16 (21.6%), 13 (17.6%), 4 (5.4%), 28 (37.8%), and 13 (17.6%) patients, respectively. Histopathologically, 17 cases (23%) were low-grade, 57 cases (77%) were high-grade. Statistically significant correlation was observed between overall survival and lymph node metastasis, distant metastasis, tumor necrosis, and differentiation by univariate analysis. Only distant metastasis was statistically associated with overall survival by multivariate analysis. We found no significant relationship between disease-free survival and all parameters. Conclusion Differentiation and necrosis of tumor, lymph node involvement, and presence of distant metastasis is associated with the overall survival of urothelial carcinoma of the upper urinary system.
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Affiliation(s)
- Sümeyye EKMEKCİ
- Department of Pathology, Health Sciences University Tepecik Training and Research Hospital, İzmirTurkey
| | - Ülkü KÜÇÜK
- Department of Pathology, Health Sciences University Tepecik Training and Research Hospital, İzmirTurkey
| | - Yelda DERE
- Department of Pathology, Faculty of Medicine, Muğla Sıtkı Koçman University, MuğlaTurkey
| | - Ebru ÇAKIR
- Department of Pathology, Atatürk Training and Research Hospital, Faculty of Medicine, Katip Çelebi University, İzmirTurkey
| | - Hatice Ceren SAYAR
- Department of Pathology, Health Sciences University Tepecik Training and Research Hospital, İzmirTurkey
| | - Batuhan ERGANİ
- Department of Urology, Health Sciences University Tepecik Training and Research Hospital, İzmirTurkey
| | - Özgür ÇAKMAK
- Department of Urology, Health Sciences University Tepecik Training and Research Hospital, İzmirTurkey
| | - Ozan BOZKURT
- Department of Urology, Faculty of Medicine, Dokuz Eylül University, İzmirTurkey
| | - Kutsal YÖRÜKOĞLU
- Department of Pathology, Faculty of Medicine, Dokuz Eylül University, IzmirTurkey
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Lymph node dissection could bring survival benefits to patients diagnosed with clinically node-negative upper urinary tract urothelial cancer: a population-based, propensity score-matched study. Int J Clin Oncol 2018; 24:296-305. [DOI: 10.1007/s10147-018-1356-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 10/04/2018] [Indexed: 10/28/2022]
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13
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Prognostic Factors and Risk Stratification in Invasive Upper Tract Urothelial Carcinoma. Clin Genitourin Cancer 2018; 16:e751-e760. [DOI: 10.1016/j.clgc.2018.01.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/26/2018] [Accepted: 01/27/2018] [Indexed: 01/22/2023]
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14
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Guo R, Zhu Y, Xiong G, Li X, Zhang K, Zhou L. Role of lymph node dissection in the management of upper tract urothelial carcinomas: a meta-analysis. BMC Urol 2018; 18:24. [PMID: 29636103 PMCID: PMC5894184 DOI: 10.1186/s12894-018-0336-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 03/13/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Lymph node dissection (LND) is not routinely performed during radical nephroureterectomy (RNU) in upper tract urothelial carcinomas (UTUC) and the role of LND has been controversial. We aim to investigate whether patients with LND had improved survival in UTUC patients. METHODS We performed a systematic literature search of PubMed, Embase, and Cochrane library for citations published prior to January 2016, describing LND performed among UTUC patients and conducted a standard meta-analysis of survival outcomes. RESULTS Eleven eligible studies containing 7516 patients satisfied the inclusion criteria. Pooled HRs for cancer-specific survival (CSS) and recurrence-free survival (RFS) were 1.17 (P = 0.18) and 1.33 (P = 0.19) respectively. However, the patients in the LND group had more advanced tumour stages and grades (P < 0.001). Further subgroup analysis showed that among muscle-invasive UTUC patients, the pooled HR for CSS and RFS were 1.10 (P = 0.42) and 0.92 (P = 0.72) respectively. Besides, no difference was found in CSS and RFS between pN0 and pNx individuals in overall populations and in patients with muscle-invasive UTUC, while pN+ patients had significantly worse prognosis when compared to pN0 patients. CONCLUSIONS LND during RNU allows more accurate staging and prediction of survival, but it remains uncertain whether LND independently improves survival in patients with UTUC. However, standard use of LND should be further investigated in a multi-center, prospective evaluation to obtain a definitive statement regarding this matter.
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Affiliation(s)
- Runqi Guo
- Department of Urology, Peking University First Hospital and Institute of Urology, National Research Center for Genitourinary Oncology, Beijing, 100034, China
| | - Yuze Zhu
- Department of Urology, Peking University First Hospital and Institute of Urology, National Research Center for Genitourinary Oncology, Beijing, 100034, China
| | - Gengyan Xiong
- Department of Urology, Peking University First Hospital and Institute of Urology, National Research Center for Genitourinary Oncology, Beijing, 100034, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital and Institute of Urology, National Research Center for Genitourinary Oncology, Beijing, 100034, China
| | - Kai Zhang
- Department of Urology, Peking University First Hospital and Institute of Urology, National Research Center for Genitourinary Oncology, Beijing, 100034, China.
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital and Institute of Urology, National Research Center for Genitourinary Oncology, Beijing, 100034, China.
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Sathianathen NJ, Risk MC, Konety BR. Lymphadenectomy for Muscle-Invasive Bladder Cancer and Upper Tract Urothelial Cell Carcinoma. Urol Clin North Am 2018; 45:215-228. [PMID: 29650137 DOI: 10.1016/j.ucl.2017.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
There are currently no reported randomized trials that characterize the staging or therapeutic benefit of performing a lymph node dissection in either bladder cancer or upper tract urothelial carcinoma. Several unanswered questions remain in this domain focused on the indications and patient selection for pelvic lymph node dissection, extent of dissection, its impact on outcome, and potential risks. However, the results of observational studies suggest that the burden of metastasis is high in both diseases when muscle invasive and performing a lymphadenectomy can provide prognostic information and yield therapeutic benefit.
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Affiliation(s)
- Niranjan J Sathianathen
- Department of Urology, University of Minnesota, Delaware Street Southeast, Minneapolis, MN 55455, USA
| | - Michael C Risk
- Department of Urology, University of Minnesota, Delaware Street Southeast, Minneapolis, MN 55455, USA
| | - Badrinath R Konety
- Department of Urology, University of Minnesota, Delaware Street Southeast, Minneapolis, MN 55455, USA.
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Kodama Y, Kondo T, Matsumura N, Shimokawa T, Kohjimoto Y, Tanabe K, Hara I. Molecular diagnosis of lymph node metastasis in patients with upper urinary tract cancer who underwent lymphadenectomy. Int J Urol 2017; 24:799-806. [DOI: 10.1111/iju.13429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 07/04/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Yoshiki Kodama
- Department of Urology; Wakayama Medical University; Wakayama Japan
| | - Tsunenori Kondo
- Department of Urology; Tokyo Women's Medical University; Tokyo Japan
| | | | - Toshio Shimokawa
- Clinical Research Center; Wakayama Medical University; Wakayama Japan
| | - Yasuo Kohjimoto
- Department of Urology; Wakayama Medical University; Wakayama Japan
| | - Kazunari Tanabe
- Department of Urology; Tokyo Women's Medical University; Tokyo Japan
| | - Isao Hara
- Department of Urology; Wakayama Medical University; Wakayama Japan
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Inokuchi J, Kuroiwa K, Kakehi Y, Sugimoto M, Tanigawa T, Fujimoto H, Gotoh M, Masumori N, Ogawa O, Eto M, Ohyama C, Yamaguchi A, Matsuyama H, Ichikawa T, Asano T, Mizusawa J, Eba J, Naito S. Role of lymph node dissection during radical nephroureterectomy for upper urinary tract urothelial cancer: multi-institutional large retrospective study JCOG1110A. World J Urol 2017; 35:1737-1744. [DOI: 10.1007/s00345-017-2049-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 05/08/2017] [Indexed: 02/06/2023] Open
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18
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Inokuchi J, Eto M, Hara T, Fujimoto H, Nishiyama H, Miyazaki J, Kikuchi E, Hinotsu S, Koie T, Ohyama C. Impact of lymph node dissection on clinical outcomes during nephroureterectomy in patients with clinically node-negative upper urinary tract urothelial cancer: subanalysis of a multi-institutional nationwide case series of the Japanese Urological Association. Jpn J Clin Oncol 2017; 47:652-659. [DOI: 10.1093/jjco/hyx051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 03/22/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Junichi Inokuchi
- Working Group of the Renal Pelvic and Ureteral Cancer Registration Committee of the Japanese Urological Association
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Masatoshi Eto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Tomohiko Hara
- Working Group of the Renal Pelvic and Ureteral Cancer Registration Committee of the Japanese Urological Association
- Urology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroyuki Fujimoto
- Working Group of the Renal Pelvic and Ureteral Cancer Registration Committee of the Japanese Urological Association
- Urology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroyuki Nishiyama
- Working Group of the Renal Pelvic and Ureteral Cancer Registration Committee of the Japanese Urological Association
- Department of Urology, Faculty of Medicine, University of Tsukuba, Ibaraki
| | - Jun Miyazaki
- Working Group of the Renal Pelvic and Ureteral Cancer Registration Committee of the Japanese Urological Association
- Department of Urology, Faculty of Medicine, University of Tsukuba, Ibaraki
| | - Eiji Kikuchi
- Working Group of the Renal Pelvic and Ureteral Cancer Registration Committee of the Japanese Urological Association
- Department of Urology, Keio University School of Medicine, Tokyo
| | - Shiro Hinotsu
- Working Group of the Renal Pelvic and Ureteral Cancer Registration Committee of the Japanese Urological Association
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama
| | - Takuya Koie
- Working Group of the Renal Pelvic and Ureteral Cancer Registration Committee of the Japanese Urological Association
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Chikara Ohyama
- Working Group of the Renal Pelvic and Ureteral Cancer Registration Committee of the Japanese Urological Association
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Moschini M, Foerster B, Abufaraj M, Soria F, Seisen T, Roupret M, Colin P, De la Taille A, Peyronnet B, Bensalah K, Herout R, Wirth MP, Novotny V, Chlosta P, Bandini M, Montorsi F, Simone G, Gallucci M, Romeo G, Matsumoto K, Karakiewicz P, Briganti A, Shariat SF. Trends of lymphadenectomy in upper tract urothelial carcinoma (UTUC) patients treated with radical nephroureterectomy. World J Urol 2017; 35:1541-1547. [DOI: 10.1007/s00345-017-2026-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 02/15/2017] [Indexed: 02/04/2023] Open
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20
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Campi R, Minervini A, Mari A, Hatzichristodoulou G, Sessa F, Lapini A, Sessa M, Gschwend JE, Serni S, Roscigno M, Carini M. Anatomical templates of lymph node dissection for upper tract urothelial carcinoma: a systematic review of the literature. Expert Rev Anticancer Ther 2017; 17:235-246. [PMID: 28103449 DOI: 10.1080/14737140.2017.1285232] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Indications and techniques of lymph node dissection (LND) for upper tract urothelial carcinoma (UTUC) are still controversial. Areas covered: In this study, a systematic review of the English-language literature was performed up to 1 July 2016 using the Medline, Scopus, Cochrane Library and Web of Sciences databases to provide a detailed overview of the most commonly dissected surgical templates of LND for UTUC according to laterality and location of the tumor. Overall, sixteen studies were analyzed. Based on the shared experiences in the scientific literature, the LND template typically included: for right-sided tumors of the renal pelvis, upper third and middle third of the ureter, the renal hilar, paracaval, precaval and retrocaval nodes, while for left-sided tumors the renal hilar, paraaortic and preaortic nodes. For tumors of the lower ureter, an extended pelvic LND was performed in most cases; however, the paracaval, paraaortic or presacral nodes were dissected in selected series. Expert commentary: LND is not routinely performed at the time of surgery for UTUC and both indication and extent of LND vary among surgeons and institutions. Future high-quality studies are needed to define the most accurate LND templates and to assess their oncological efficacy and surgical morbidity.
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Affiliation(s)
- Riccardo Campi
- a Department of Urology , Careggi Hospital, University of Florence , Florence , Italy
| | - Andrea Minervini
- a Department of Urology , Careggi Hospital, University of Florence , Florence , Italy
| | - Andrea Mari
- a Department of Urology , Careggi Hospital, University of Florence , Florence , Italy
| | - Georgios Hatzichristodoulou
- b Department of Urology , Klinik und Poliklinik für Urologie, Technische Universität München (TUM), Klinikum rechts der Isar , Munich , Germany
| | - Francesco Sessa
- a Department of Urology , Careggi Hospital, University of Florence , Florence , Italy
| | - Albero Lapini
- a Department of Urology , Careggi Hospital, University of Florence , Florence , Italy
| | - Maurizio Sessa
- c Department of Experimental Medicine , Section of Pharmacology 'L. Donatelli', II University of Naples , Naples , Italy
| | - Jurgen Erich Gschwend
- b Department of Urology , Klinik und Poliklinik für Urologie, Technische Universität München (TUM), Klinikum rechts der Isar , Munich , Germany
| | - Sergio Serni
- a Department of Urology , Careggi Hospital, University of Florence , Florence , Italy
| | - Marco Roscigno
- d Department of Urology , AO Papa Giovanni XXIII , Bergamo , Italy
| | - Marco Carini
- a Department of Urology , Careggi Hospital, University of Florence , Florence , Italy
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Petrelli F, Yasser Hussein MI, Vavassori I, Barni S. Prognostic Factors of Overall Survival in Upper Urinary Tract Carcinoma: A Systematic Review and Meta-analysis. Urology 2017; 100:9-15. [DOI: 10.1016/j.urology.2016.07.036] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/27/2016] [Accepted: 07/29/2016] [Indexed: 01/27/2023]
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22
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Yoo S, You D, Jeong IG, Hong B, Hong JH, Ahn H, Kim CS. Does lymph node dissection during nephroureterectomy affect oncological outcomes in upper tract urothelial carcinoma patients without suspicious lymph node metastasis on preoperative imaging studies? World J Urol 2016; 35:665-673. [DOI: 10.1007/s00345-016-1918-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 08/02/2016] [Indexed: 12/17/2022] Open
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Template-based lymphadenectomy reduces the risk of regional lymph node recurrence among patients with upper/middle ureteral cancer. Int J Clin Oncol 2016; 22:145-152. [DOI: 10.1007/s10147-016-1024-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 07/12/2016] [Indexed: 01/26/2023]
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24
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Shibing Y, Liangren L, Qiang W, Hong L, Turun S, Junhao L, Lu Y, Zhengyong Y, Yonghao J, Guangqing F, Yunxiang L, Dehong C. Impact of tumour size on prognosis of upper urinary tract urothelial carcinoma after radical nephroureterectomy: a multi-institutional analysis of 795 cases. BJU Int 2016; 118:902-910. [PMID: 26935344 DOI: 10.1111/bju.13463] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Yan Shibing
- Department of Urology; Institute of Urology; West China Hospital; Sichuan University; Chengdu Sichuan Province China
- Department of Urology; Dujiangyan Medical Center/Affiliated Hospital of Chengdu University; Dujiangyan City Sichuan Province China
| | - Liu Liangren
- Department of Urology; Institute of Urology; West China Hospital; Sichuan University; Chengdu Sichuan Province China
| | - Wei Qiang
- Department of Urology; Institute of Urology; West China Hospital; Sichuan University; Chengdu Sichuan Province China
| | - Liao Hong
- Department of Urology; Sichuan Provincial Cancer Hospital/the Second Provincial Hospital of Sichuan Province; Chengdu Sichuan Province China
| | - Song Turun
- Department of Urology; Institute of Urology; West China Hospital; Sichuan University; Chengdu Sichuan Province China
| | - Lei Junhao
- Department of Urology; Institute of Urology; West China Hospital; Sichuan University; Chengdu Sichuan Province China
| | - Yang Lu
- Department of Urology; Institute of Urology; West China Hospital; Sichuan University; Chengdu Sichuan Province China
| | - Yuan Zhengyong
- Department of Urology; Dujiangyan Medical Center/Affiliated Hospital of Chengdu University; Dujiangyan City Sichuan Province China
- Department of Urology; First Affiliated Hospital of Chongqing Medical University; Chongqing Sichuan Province China
| | - Jiang Yonghao
- Department of Urology; Second People's Hospital of Yibin City; Yibin City Sichuan Province China
| | - Fu Guangqing
- Department of Urology; Fourth People's Hospital of Zigong City; Zigong City Sichuan Province China
| | - Li Yunxiang
- Department of Urology; Nanchong Central Hospital; Nanchong City Sichuan Province China
| | - Cao Dehong
- Department of Urology; Institute of Urology; West China Hospital; Sichuan University; Chengdu Sichuan Province China
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Contemporary role of lymph node dissection at the time of radical nephroureterectomy for upper tract urothelial carcinoma. World J Urol 2016; 35:535-548. [PMID: 26809456 DOI: 10.1007/s00345-016-1764-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 01/05/2016] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To review the contemporary data on the role of lymph node dissection (LND) at the time of radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). METHODS A computerized bibliographic search using the following protocol ("Nephroureterectomy") AND ("Lymphadenectomy" OR "Lymph node" OR "Lymphatic") was performed in MEDLINE to identify all original and review articles that addressed the role of LND for UTUC. RESULTS Regional lymph node (LN) boundaries of UTUC have been recently investigated in mapping studies to propose anatomic templates of LND according to the laterality and location of primary tumor. Although these anatomic templates remained poorly described, most reports supported the staging benefit of LND that allowed for risk stratification of patients with (pN+) or without (pN0) LN metastases from those who did not undergo such a procedure (pNx). In addition, the therapeutic benefit of LND at the time of RNU was supported by better oncological outcomes obtained after complete LND when compared to incomplete or no LND, especially in the group of patients with advanced disease. The number of LNs removed was also correlated with both, more accurate staging and greater cancer-specific survival after LND, whose feasibility and safety have been validated in prospective studies. CONCLUSIONS Despite mostly based on data with level of evidence 3, our comprehensive review of the literature supports the staging and therapeutic benefits of LND at the time of RNU for UTUC, which are particularly significant for patients with muscle-invasive or locally advanced disease.
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Kondo T, Takagi T, Tanabe K. Therapeutic role of template-based lymphadenectomy in urothelial carcinoma of the upper urinary tract. World J Clin Oncol 2015; 6:237-51. [PMID: 26677437 PMCID: PMC4675909 DOI: 10.5306/wjco.v6.i6.237] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/14/2015] [Accepted: 10/01/2015] [Indexed: 02/06/2023] Open
Abstract
Lymphadenectomy for urothelial carcinoma of the upper urinary tract has attracted the attention of physicians. The mapping study of lymphatic spread has shown that a relatively wide area should comprise the regional nodes for tumors of the right renal pelvis or the right upper two-thirds of the ureter. A prospective study showed that an anatomical template-based lymphadenectomy significantly improved patient survival in tumors of the renal pelvis. This benefit was more evident for patients with pT2 stage tumors or higher. The risk of regional node recurrence is significant reduced by template-based lymphadenectomy, which is likely to be associated with improved patient survival. The removal of lymph node micrometastases is assumed to be the reason for therapeutic benefit following lymphadenectomy. The number of resected lymph nodes can be used to assess the quality of lymphadenectomy, but not to determine the extent of lymphadenectomy. The guidelines currently recommend lymphadenectomy for patients with muscle-invasive disease, even though the current recommendation grades are still low. The present limitation of lymphadenectomy is the lack of standardization of the extent of lymphadenectomy and the randomized trials. Further studies are warranted to collect the evidence to support lymphadenectomy.
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TALL score for prediction of oncological outcomes after radical nephroureterectomy for high-grade upper tract urothelial carcinoma. World J Urol 2015; 33:1965-72. [DOI: 10.1007/s00345-015-1566-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 04/13/2015] [Indexed: 11/25/2022] Open
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Abstract
PURPOSE OF REVIEW The lymph node dissection (LND) is an integral component of many oncologic surgeries. Better understanding of each cancer's behaviour and improvements in surgical techniques necessitate a critical analysis of lymph node disease and the optimal LND template. This review will focus on updates in managing lymph node disease in testicular, penile, upper tract urothelial and urethral cancer. RECENT FINDINGS For testicular and penile cancer, advances have focused on reducing the morbidity associated with the standard templates of dissection while maintaining oncologic efficacy. For upper tract urothelial carcinoma, data continue to be mixed regarding the need for a LND, though it does seem to benefit patients with advanced tumours. Little is known regarding the optimal LND template for urethral cancer. SUMMARY A thorough LND has an established diagnostic and therapeutic role in testicular and penile cancer. For upper tract urothelial carcinoma, the role of an LND remains controversial, though emerging evidence points to an association with improved outcomes. Due to the rarity of urethral cancer, there are no standard LND templates, though excising clinically positive nodes is recommended. For all these cancers, more sophisticated risk stratification based upon clinical and pathologic factors has helped determine which patients require an LND and how to best manage these patients after surgery.
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Colin P, Irani J, Drouin S, Shariat S, Rouprêt M. Facteurs pronostiques des tumeurs de la voie excrétrice supérieure et impact sur la survie : une revue systématique pour le rapport annuel de l’Association française d’urologie. Prog Urol 2014; 24:1000-10. [DOI: 10.1016/j.purol.2014.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 07/16/2014] [Accepted: 07/22/2014] [Indexed: 02/02/2023]
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Kondo T, Hara I, Takagi T, Kodama Y, Hashimoto Y, Kobayashi H, Iizuka J, Omae K, Ikezawa E, Yoshida K, Tanabe K. Possible role of template-based lymphadenectomy in reducing the risk of regional node recurrence after nephroureterectomy in patients with renal pelvic cancer. Jpn J Clin Oncol 2014; 44:1233-8. [PMID: 25271269 DOI: 10.1093/jjco/hyu151] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE It remains unclear whether lymphadenectomy alters regional node recurrence after nephroureterectomy in patients with urothelial carcinoma of the renal pelvis. The predictive factors for regional node recurrence are still unclear. In this study, we retrospectively examined how the extent of lymphadenectomy influences regional node recurrence in patients with urothelial carcinoma of the renal pelvis. METHODS From January 1988 through July 2013, we performed nephroureterectomy in 180 patients with non-metastatic (cN0M0) urothelial carcinoma of the renal pelvis at two Japanese institutes. Regional nodes were determined according to our previous mapping study: complete lymphadenectomy designates that all regional sites were dissected; incomplete lymphadenectomy that all sites were not dissected. A third group included those without lymphadenectomy. RESULTS The 5-year cancer-specific and recurrence-free survival was significantly higher in the complete lymphadenectomy group than in the incomplete lymphadenectomy or without lymphadenectomy groups (P = 0.03). The incidence of regional node recurrence was significantly lower in the complete lymphadenectomy group at 2.9% (2/67) than in the incomplete lymphadenectomy at 18.1% (4/22) or without lymphadenectomy at 10.9% (10/91) groups (P = 0.03). In patients with incomplete lymphadenectomy, 75% of regional node recurrence occurred outside of the dissected sites. Complete lymphadenectomy is shown to be a likely predictive factor of reduced risk of recurrence at the regional nodes by multivariate analysis, after adjusting for patient age, pathological T stage, and pathological nodal metastases. CONCLUSIONS This study shows that template-based lymphadenectomy reduced the risk of regional node recurrence in patients with urothelial carcinoma of the renal pelvis and appears to result in improved survival.
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Affiliation(s)
- Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University, Tokyo
| | - Isao Hara
- Department of Urology, Wakayama Medical University, Wakayama, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, Tokyo
| | - Yoshiki Kodama
- Department of Urology, Wakayama Medical University, Wakayama, Japan
| | | | | | - Junpei Iizuka
- Department of Urology, Tokyo Women's Medical University, Tokyo
| | - Kenji Omae
- Department of Urology, Tokyo Women's Medical University, Tokyo
| | - Eri Ikezawa
- Department of Urology, Tokyo Women's Medical University, Tokyo
| | | | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, Tokyo
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Marshall S, Stifelman M. Robot-assisted surgery for the treatment of upper urinary tract urothelial carcinoma. Urol Clin North Am 2014; 41:521-37. [PMID: 25306164 DOI: 10.1016/j.ucl.2014.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Robot-assisted laparoscopic surgery is increasingly used in urologic oncologic surgery. Robotic nephroureterectomy is still a relatively new technique. As upper tract urothelial carcinoma is a rare disease, intermediate- and long-term outcome data are scarce. However, robotic nephroureterectomy does seem to offer advantages to open and laparoscopic counterparts, with comparable short-term oncologic and functional outcomes. Here the authors review the robotic surgical management of upper tract urothelial carcinoma, with a review of the steps and tips on making this approach more widely adoptable.
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Affiliation(s)
- Susan Marshall
- Department of Urology, NYU Langone Medical Center, 150 East 32nd Street, 2nd Floor, New York, NY 10016, USA.
| | - Michael Stifelman
- Department of Urology, NYU Langone Medical Center, 150 East 32nd Street, 2nd Floor, New York, NY 10016, USA
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Kapoor A, Allard CB, Black P, Kassouf W, Morash C, Rendon R. Canadian guidelines for postoperative surveillance of upper urinary tract urothelial carcinoma. Can Urol Assoc J 2013; 7:306-11. [PMID: 24319507 DOI: 10.5489/cuaj.1578] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Anil Kapoor
- Division of Urology, McMaster University, Hamilton, ON
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Kondo T, Hara I, Takagi T, Kodama Y, Hashimoto Y, Kobayashi H, Iizuka J, Omae K, Yoshida K, Tanabe K. Template-based lymphadenectomy in urothelial carcinoma of the renal pelvis: A prospective study. Int J Urol 2013. [DOI: 10.1111/iju.12338] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Tsunenori Kondo
- Department of Urology; Tokyo Women's Medical University; Tokyo Japan
| | - Isao Hara
- Department of Urology; Wakayama Medical University; Wakayama Japan
| | - Toshio Takagi
- Department of Urology; Tokyo Women's Medical University; Tokyo Japan
| | - Yoshiki Kodama
- Department of Urology; Wakayama Medical University; Wakayama Japan
| | | | | | - Junpei Iizuka
- Department of Urology; Tokyo Women's Medical University; Tokyo Japan
| | - Kenji Omae
- Department of Urology; Tokyo Women's Medical University; Tokyo Japan
| | - Kazuhiko Yoshida
- Department of Urology; Tokyo Women's Medical University; Tokyo Japan
| | - Kazunari Tanabe
- Department of Urology; Tokyo Women's Medical University; Tokyo Japan
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Colin P, Ghoneim TP, Nison L, Seisen T, Lechevallier E, Cathelineau X, Ouzzane A, Zerbib M, Long JA, Ruffion A, Crouzet S, Cussenot O, Audouin M, Irani J, Gardic S, Gres P, Audenet F, Roumiguié M, Valeri A, Rouprêt M. Risk stratification of metastatic recurrence in invasive upper urinary tract carcinoma after radical nephroureterectomy without lymphadenectomy. World J Urol 2013; 32:507-12. [DOI: 10.1007/s00345-013-1116-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 06/07/2013] [Indexed: 10/26/2022] Open
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Bensalah K, Roupret M, Xylinas E, Shariat S. The survival benefit of lymph node dissection at the time of removal of kidney, prostate and urothelial carcinomas: what is the evidence? World J Urol 2013; 31:1369-76. [PMID: 23588812 DOI: 10.1007/s00345-013-1064-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 03/16/2013] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Lymph node dissection (LND) has been advocated by oncologic surgeons to completely eradicate cancer. However, evidence for that strategy is solely based on poor quality data. Some randomized studies done outside the field of urology failed to show any benefit to LND. Our objective was to evaluate whether LND at the time of removal of prostate, kidney and urothelial carcinomas results in a survival benefit. METHODS For that purpose, we performed a systematic literature review. RESULTS For kidney cancer, LND might be able to cure some patients with N+ disease. In N0 patients, although a randomized trial has been completed, the value of LND remains uncertain. LND at the time of radical prostatectomy can be useful in some patients with lymph node invasion. However, studies on the impact of LND in pN0 patients are retrospective and conflictive. Extended LND has been recommended when performing a radical cystectomy based on improved outcomes observed in retrospective studies. However, these studies are limited by selection biases and results of ongoing randomized trials will specify the template and the advantages of LND when removing a bladder cancer. Recent data of large series of radical nephro-ureterectomies for upper tract urothelial carcinomas are conflicting. Some found a benefit of LND in N0 patients while others did not. CONCLUSION The studies that support LND at the time of surgery for prostate, kidney and urothelial carcinomas have low level of evidence. This should encourage urologists to design and perform well-designed randomized trials to assess the potential survival impact of a commonly done procedure.
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Affiliation(s)
- Karim Bensalah
- Department of Urology, Rennes University Hospital, University of Rennes, 2, rue Henri Le Guillou, 35000, Rennes, France,
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Hurel S, Rouprêt M, Ouzzane A, Rozet F, Xylinas E, Zerbib M, Berod AA, Ruffion A, Adam E, Cussenot O, Houlgatte A, Phé V, Nouhaud FX, Bensadoun H, Delage F, Guillotreau J, Guy L, Karsenty G, De La Taille A, Colin P. Impact of lymphovascular invasion on oncological outcomes in patients with upper tract urothelial carcinoma after radical nephroureterectomy. BJU Int 2013; 111:1199-207. [DOI: 10.1111/bju.12116] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Sophie Hurel
- Department of Urology; Côte de Nacre Hospital; CHU Caen; Caen
| | - Morgan Rouprêt
- Department of Urology; la Pitié Salpetrière Hospital; AP-HP; Paris
| | - Adil Ouzzane
- Department of Urology; Claude Huriez Hospital; CHRU Lille; Lille
| | - François Rozet
- Department of Urology; Institut Mutualiste Montsouris; Paris
| | | | - Marc Zerbib
- Department of Urology; Cochin Hospital; AP-HP; Paris
| | - Alexis Arvin Berod
- Department of Urology; Albert Michallon Hospital; CHU Grenoble; Grenoble
| | | | - Emilie Adam
- Department of Urology; Edouard Herriot Hospital; CHU Lyon; Lyon
| | | | - Alain Houlgatte
- Department of Urology; Val de Grâce Military Hospital; Paris
| | | | | | - Henri Bensadoun
- Department of Urology; Côte de Nacre Hospital; CHU Caen; Caen
| | - Francky Delage
- Department of Urology la Cavale Blanche Hospital; CHU Brest; Brest
| | | | - Laurent Guy
- Department of Urology; Gabriel-Montpied Hospital; CHU Clermont-Ferrand; Clermont-Ferrand
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Affiliation(s)
- Michael J Leveridge
- Assistant Professor, Departments of Urology and Oncology, Queen's University, Kingston, ON
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The impact of lymph node status and features on oncological outcomes in urothelial carcinoma of the upper urinary tract (UTUC) treated by nephroureterectomy. World J Urol 2012; 31:189-97. [PMID: 23229227 DOI: 10.1007/s00345-012-0983-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 10/29/2012] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Prognostic impact of lymphadenectomy during radical nephroureterectomy (RNU) for urothelial carcinoma of the upper urinary tract (UTUC) is controversial. Our aim was to assess the impact of lymph node status (LNS) on survival in patients treated by RNU. METHODS In our multi-institutional, retrospective database, 714 patients with non-metastatic UTUC had undergone RNU between 1995 and 2010. LNS was tested as prognostic factor for survivals through univariate and multivariable Cox regression analysis. RESULTS Median age was 70 years [interquartile range (IQR), 60-75] with median follow-up of 27 months (IQR, 10-50). Overall, lymphadenectomy was performed in 254 patients (35.5 %). Among these patients, 204 (80 %) had negative lymph nodes (pN0) and 50 (20 %) had positive lymph nodes (pN1/2). The 5-year cancer-specific survival (CSS) was 81 % [95 % confidence interval (CI), 73-88 %] for pN0 patients, 85 % (95 % CI, 80-90 %) for pNx patients and 47 % (95 % CI, 24-69 %) for pN1/2 patients (p < 0.001). Metastasis-free survival (MFS) and overall survival (OS) rates were significantly lower in pN1/2 patients than in pN0 and pNx patients (p < 0.05). On multivariable analysis, LNS did not appear as an independent prognostic factor for CSS, OS or MFS (p > 0.05). In case of lymph node involvement, extra-nodal extension was marginally associated with worse CSS (log rank p = 0.07). The retrospective design was the main limitation. CONCLUSION LNS is helpful for survival stratification in patients treated with RNU for UTUC. However, LNS did not appear as an independent predictor of survival in this retrospective series and needs to be investigated in a large multicentre, prospective evaluation.
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