Abstract
Purpose
To evaluate the effect of lymphadenectomy (LND) in conjunction with nephroureterectomy on cancer-specific mortality (CSM) and overall survival (OS) for patients with muscle-invasive UTUC.
Methods
A retrospective, multicenter study of patients with UTUC, clinical stage N0M0, who underwent nephroureterectomy between January 2008 and December 2014 was conducted. Outcome measures were OS and CSM.
Results
In total, 298 patients underwent robot-assisted or laparoscopic radical nephroureterectomy with a final histological diagnosis of UTUC. LND was performed in 46 (15.4%). One hundred and seventy-two patients (62%) had non-muscle-invasive disease (NMID); 105 patients (38%) had muscle-invasive disease (MID). Median time of follow-up was 43.5 months (95% CI 36.0–47.2). For patients with MID, the 5-year cumulative incidence of all-cause mortality and CSM was 73.5% (95% CI 60.4–86.6) and 52.4% (95% CI 38.9–65.9), respectively (p < 0.0001). There was no significant difference in OS between patients with N1 and patients with N0 disease (p = 0.53). The 5-year OS rates were 30.5% (95% CI 6.6–54.4) and 25.7% (95% CI 10.9–40.5), respectively. This study is limited by its retrospective nature. There may also have been bias in the selection of patients undergoing LND.
Conclusions
Five-year OS and CSM are comparable between patients with N1 and N0 MID. This evidence may support the use of the LND procedure in patients with muscle-invasive UTUC.
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Abbreviations
- UTUC:
-
Upper urinary tract urothelial carcinoma
- LND:
-
Extended lymphadenectomy
- OS:
-
Overall survival
- CSM:
-
Cancer-specific mortality
- CT:
-
Computed tomography
- pN1:
-
Lymph nodes with malignant cells
- RR:
-
Relative risks
- HRs:
-
Hazard ratios
- CI:
-
Confidence interval
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Azawi, N.H., Berg, K.D., Thamsborg, A.K.M. et al. Laparoscopic and robotic nephroureterectomy: does lymphadenectomy have an impact on the clinical outcome?. Int Urol Nephrol 49, 1785–1792 (2017). https://doi.org/10.1007/s11255-017-1672-1
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DOI: https://doi.org/10.1007/s11255-017-1672-1