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01-02-2013 | Original Article

The impact of lymph node status and features on oncological outcomes in urothelial carcinoma of the upper urinary tract (UTUC) treated by nephroureterectomy

Authors: Adil Ouzzane, Pierre Colin, Tarek P. Ghoneim, Marc Zerbib, Alexandre De La Taille, François Audenet, Fabien Saint, Nicolas Hoarau, Emilie Adam, Marie Dominique Azemar, Henri Bensadoun, Luc Cormier, Olivier Cussenot, Alain Houlgatte, Gilles Karsenty, Charlotte Maurin, François Xavier Nouhaud, Véronique Phe, Thomas Polguer, Mathieu Roumiguié, Alain Ruffion, Morgan Rouprêt

Published in: World Journal of Urology | Issue 1/2013

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.

Colin P, Koenig P, Ouzzane A, Berthon N, Villers A, Biserte J, Roupret M (2009) Environmental factors involved in carcinogenesis of urothelial cell carcinomas of the upper urinary tract. BJU Int 104(10):1436–1440. doi:10.1111/j.1464-410X.2009.08838.x PubMedCrossRef

Roupret M, Zigeuner R, Palou J, Boehle A, Kaasinen E, Sylvester R, Babjuk M, Oosterlinck W (2011) European guidelines for the diagnosis and management of upper urinary tract urothelial cell carcinomas: 2011 update. Eur Urol 59(4):584–594. doi:10.1016/j.eururo.2010.12.042 PubMedCrossRef

Zigeuner R, Pummer K (2008) Urothelial carcinoma of the upper urinary tract: surgical approach and prognostic factors. Eur Urol 53(4):720–731. doi:10.1016/j.eururo.2008.01.006 PubMedCrossRef

Sobin L, Godspodarowicz M, Wittekind C (2009) Renal pelvis and ureter. In: International Union Against Cancer (ed) TNM classification of malignant tumours. Urological tumours, 7 rev edn. Wiley-Blackwell, New York, NY, pp 258–261

Mostofi FK, Sorbin LH, Torloni H (1973) International histological classification of tumours: histological typing of urinary bladder tumours, vol 10. World Health Organization, Geneva

Dhar NB, Klein EA, Reuther AM, Thalmann GN, Madersbacher S, Studer UE (2008) Outcome after radical cystectomy with limited or extended pelvic lymph node dissection. J Urol 179(3):873–878. doi:10.1016/j.juro.2007.10.076 (discussion 878)PubMedCrossRef

Leissner J, Hohenfellner R, Thuroff JW, Wolf HK (2000) Lymphadenectomy in patients with transitional cell carcinoma of the urinary bladder; significance for staging and prognosis. BJU Int 85(7):817–823PubMedCrossRef

Holmer M, Bendahl PO, Davidsson T, Gudjonsson S, Mansson W, Liedberg F (2009) Extended lymph node dissection in patients with urothelial cell carcinoma of the bladder: can it make a difference? World J Urol 27(4):521–526. doi:10.1007/s00345-008-0366-9 PubMedCrossRef

Bolenz C, Shariat SF, Fernandez MI, Margulis V, Lotan Y, Karakiewicz P, Remzi M, Kikuchi E, Zigeuner R, Weizer A, Montorsi F, Bensalah K, Wood CG, Roscigno M, Langner C, Koppie TM, Raman JD, Mikami S, Michel MS, Strobel P (2008) Risk stratification of patients with nodal involvement in upper tract urothelial carcinoma: value of lymph-node density. BJU Int. doi:10.1111/j.1464-410X.2008.07988.x

10.

Roscigno M, Shariat SF, Margulis V, Karakiewicz P, Remzi M, Kikuchi E, Langner C, Lotan Y, Weizer A, Bensalah K, Raman JD, Bolenz C, Guo CC, Wood CG, Zigeuner R, Wheat J, Kabbani W, Koppie TM, Ng CK, Suardi N, Bertini R, Fernandez MI, Mikami S, Isida M, Michel MS, Montorsi F (2009) Impact of lymph node dissection on cancer specific survival in patients with upper tract urothelial carcinoma treated with radical nephroureterectomy. J Urol 181(6):2482–2489. doi:10.1016/j.juro.2009.02.021 PubMedCrossRef

11.

Kondo T, Nakazawa H, Ito F, Hashimoto Y, Toma H, Tanabe K (2007) Primary site and incidence of lymph node metastases in urothelial carcinoma of upper urinary tract. Urology 69(2):265–269. doi:10.1016/j.urology.2006.10.014 PubMedCrossRef

12.

Brausi MA, Gavioli M, De Luca G, Verrini G, Peracchia G, Simonini G, Viola M (2007) Retroperitoneal lymph node dissection (RPLD) in conjunction with nephroureterectomy in the treatment of infiltrative transitional cell carcinoma (TCC) of the upper urinary tract: impact on survival. Eur Urol 52(5):1414–1418. doi:10.1016/j.eururo.2007.04.070 PubMedCrossRef

13.

Roscigno M, Cozzarini C, Bertini R, Scattoni V, Freschi M, Da Pozzo LF, Briganti A, Gallina A, Capitanio U, Colombo R, Giorgio G, Montorsi F, Rigatti P (2008) Prognostic value of lymph node dissection in patients with muscle-invasive transitional cell carcinoma of the upper urinary tract. Eur Urol 53(4):794–802. doi:10.1016/j.eururo.2008.01.008 PubMedCrossRef

14.

Secin FP, Koppie TM, Salamanca JI, Bokhari S, Raj GV, Olgac S, Serio A, Vickers A, Bochner BH (2007) Evaluation of regional lymph node dissection in patients with upper urinary tract urothelial cancer. Int J Urol 14(1):26–32. doi:10.1111/j.1442-2042.2006.01664.x PubMedCrossRef

15.

Roscigno M, Brausi M, Heidenreich A, Lotan Y, Margulis V, Shariat SF, Van Poppel H, Zigeuner R (2011) Lymphadenectomy at the time of nephroureterectomy for upper tract urothelial cancer. Eur Urol 60(4):776–783. doi:10.1016/j.eururo.2011.07.009 PubMedCrossRef

16.

Caoili EM, Cohan RH, Inampudi P, Ellis JH, Shah RB, Faerber GJ, Montie JE (2005) MDCT urography of upper tract urothelial neoplasms. AJR Am J Roentgenol 184(6):1873–1881PubMed

17.

Brown GA, Matin SF, Busby JE, Dinney CP, Grossman HB, Pettaway CA, Munsell MF, Kamat AM (2007) Ability of clinical grade to predict final pathologic stage in upper urinary tract transitional cell carcinoma: implications for therapy. Urology 70(2):252–256. doi:10.1016/j.urology.2007.03.051 PubMedCrossRef

18.

Margulis V, Youssef RF, Karakiewicz PI, Lotan Y, Wood CG, Zigeuner R, Kikuchi E, Weizer A, Raman JD, Remzi M, Roscigno M, Montorsi F, Bolenz C, Kassouf W, Shariat SF (2010) Preoperative multivariable prognostic model for prediction of nonorgan confined urothelial carcinoma of the upper urinary tract. J Urol 184(2):453–458. doi:10.1016/j.juro.2010.03.142 PubMedCrossRef

19.

Burger M, Shariat SF, Fritsche HM, Martinez-Salamanca JI, Matsumoto K, Chromecki TF, Ficarra V, Kassouf W, Seitz C, Pycha A, Tritschler S, Walton TJ, Novara G (2011) No overt influence of lymphadenectomy on cancer-specific survival in organ-confined versus locally advanced upper urinary tract urothelial carcinoma undergoing radical nephroureterectomy: a retrospective international, multi-institutional study. World J Urol 29(4):465–472. doi:10.1007/s00345-011-0705-0 PubMedCrossRef

20.

Mason RJ, Kassouf W, Bell DG, Lacombe L, Kapoor A, Jacobsen N, Fairey A, Izawa J, Black P, Tanguay S, Chin J, So A, Lattouf JB, Saad F, Matsumoto E, Drachenberg D, Cagiannos I, Fradet Y, Rendon RA (2012) The contemporary role of lymph node dissection during nephroureterectomy in the management of upper urinary tract urothelial carcinoma: the Canadian experience. Urology 79(4):840–845. doi:10.1016/j.urology.2011.11.058 PubMedCrossRef

21.

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. J Urol 187(3):845–851. doi:10.1016/j.juro.2011.10.158 PubMedCrossRef

22.

Kondo T, Nakazawa H, Ito F, Hashimoto Y, Toma H, Tanabe K (2007) Impact of the extent of regional lymphadenectomy on the survival of patients with urothelial carcinoma of the upper urinary tract. J Urol 178(4 Pt 1):1212–1217. doi:10.1016/j.juro.2007.05.158 (discussion 1217)PubMedCrossRef

23.

Ouzzane A, Colin P, Xylinas E, Pignot G, Ariane MM, Saint F, Hoarau N, Adam E, Azemar MD, Bensadoun H, Cormier L, Cussenot O, Houlgatte A, Karsenty G, Bruyere F, Maurin C, Nouhaud FX, Phe V, Polguer T, Roumiguie M, Ruffion A, Roupret M (2011) Ureteral and multifocal tumours have worse prognosis than renal pelvic tumours in urothelial carcinoma of the upper urinary tract treated by nephroureterectomy. Eur Urol 60(6):1258–1265. doi:10.1016/j.eururo.2011.05.049 PubMedCrossRef

24.

Roscigno M, Shariat SF, Freschi M, Margulis V, Karakiewizc P, Suardi N, Remzi M, Zigeuner R, Bolenz C, Kikuchi E, Weizer A, Bensalah K, Sagalowsky A, Koppie TM, Raman J, Fernandez M, Strobel P, Kabbani W, Langner C, Wheat J, Guo CC, Kassouf W, Haitel A, Wood CG, Montorsi F (2009) Assessment of the minimum number of lymph nodes needed to detect lymph node invasion at radical nephroureterectomy in patients with upper tract urothelial cancer. Urology 74(5):1070–1074. doi:10.1016/j.urology.2009.04.084 PubMedCrossRef

Title: The impact of lymph node status and features on oncological outcomes in urothelial carcinoma of the upper urinary tract (UTUC) treated by nephroureterectomy
Authors: Adil Ouzzane
Pierre Colin
Tarek P. Ghoneim
Marc Zerbib
Alexandre De La Taille
François Audenet
Fabien Saint
Nicolas Hoarau
Emilie Adam
Marie Dominique Azemar
Henri Bensadoun
Luc Cormier
Olivier Cussenot
Alain Houlgatte
Gilles Karsenty
Charlotte Maurin
François Xavier Nouhaud
Véronique Phe
Thomas Polguer
Mathieu Roumiguié
Alain Ruffion
Morgan Rouprêt
Publication date: 01-02-2013
Publisher: Springer-Verlag
Published in: World Journal of Urology / Issue 1/2013
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-012-0983-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The impact of lymph node status and features on oncological outcomes in urothelial carcinoma of the upper urinary tract (UTUC) treated by nephroureterectomy

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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