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01-11-2017 | Original Article

Role of lymph node dissection during radical nephroureterectomy for upper urinary tract urothelial cancer: multi-institutional large retrospective study JCOG1110A

Authors: Junichi Inokuchi, Kentaro Kuroiwa, Yoshiyuki Kakehi, Mikio Sugimoto, Toshiki Tanigawa, Hiroyuki Fujimoto, Momokazu Gotoh, Naoya Masumori, Osamu Ogawa, Masatoshi Eto, Chikara Ohyama, Akito Yamaguchi, Hideyasu Matsuyama, Tomohiko Ichikawa, Tomohiko Asano, Junki Mizusawa, Junko Eba, Seiji Naito

Published in: World Journal of Urology | Issue 11/2017

Abstract

Purpose

To evaluate the impact of lymph node dissection (LND) on clinical outcome during radical nephroureterectomy (RNU) for patients with upper urinary tract urothelial cancer (UTUC).

Methods

We, the Urologic Oncology Study Group of the Japan Clinical Oncology Group (JCOG), retrospectively collected data from patients with non-metastatic UTUC who underwent RNU in 30 centers in 1995–2009. Ineligible patients and patients with previous and/or synchronous bladder cancer were excluded, and the remaining 2037 patients were analyzed. We compared overall and cancer-specific mortality between patients who underwent LND (LND group) and those without LND (no-LND group).

Results

Among 2037 patients, LND was performed in 1046 (51.4%) patients, and 223 (10.9%) patients had pathological node-positive (pN+) disease. All-cause mortality was observed in 503 patients (24.7%) during follow-up (median 45.8 months), including 363 patients (17.8%) who died of UTUC. Patients with pN+ disease showed significantly shorter overall survival (OS) compared with pN0 patients, and the estimated 5-year OS for pN+ patients was 30%. Older age, ≥cT3, and clinical node-positive disease were found as preoperative predictors for pN+ disease by multivariate analysis. In the comparison of OS and cancer-specific mortality between LND and no-LND groups, there was no significant improvement by LND in multivariate analysis. The median number of lymph nodes removed was six (IQR 3–11). There was no significant association between the number of lymph nodes removed and OS.

Conclusions

The present study indicates that there is no therapeutic benefit of LND during RNU for UTUC, although pathologically positive LN status can predict poor prognosis.

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Roupret M, Babjuk M, Comperat E, Zigeuner R, Sylvester RJ, Burger M, Cowan NC, Bohle A, Van Rhijn BW, Kaasinen E, Palou J, Shariat SF (2015) European association of urology guidelines on upper urinary tract urothelial cell carcinoma: 2015 update. Eur Urol 68(5):868–879. doi:10.1016/j.eururo.2015.06.044 CrossRefPubMed

Seisen T, Shariat SF, Cussenot O, Peyronnet B, Renard-Penna R, Colin P, Roupret M (2016) Contemporary role of lymph node dissection at the time of radical nephroureterectomy for upper tract urothelial carcinoma. World J Urol. doi:10.1007/s00345-016-1764-z PubMed

Messer J, Lin YK, Raman JD (2011) The role of lymphadenectomy for upper tract urothelial carcinoma. Nat Rev Urol 8(7):394–401. doi:10.1038/nrurol.2011.78 CrossRefPubMed

Bruins HM, Veskimae E, Hernandez V, Imamura M, Neuberger MM, Dahm P, Stewart F, Lam TB, N’Dow J, van der Heijden AG, Comperat E, Cowan NC, De Santis M, Gakis G, Lebret T, Ribal MJ, Sherif A, Witjes JA (2014) The impact of the extent of lymphadenectomy on oncologic outcomes in patients undergoing radical cystectomy for bladder cancer: a systematic review. Eur Urol 66(6):1065–1077. doi:10.1016/j.eururo.2014.05.031 CrossRefPubMed

Abe T, Shinohara N, Harabayashi T, Sazawa A, Ishikawa S, Kubota K, Matsuno Y, Osawa T, Shibata T, Shinno Y, Kamota S, Minami K, Sakashita S, Takeuchi I, Kumagai A, Mori T, Togashi M, Nonomura K (2008) The role of lymph-node dissection in the treatment of upper urinary tract cancer: a multi-institutional study. BJU Int 102(5):576–580. doi:10.1111/j.1464-410X.2008.07673.x CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

Lughezzani G, Jeldres C, Isbarn H, Shariat SF, Sun M, Pharand D, Widmer H, Arjane P, Graefen M, Montorsi F, Perrotte P, Karakiewicz PI (2010) A critical appraisal of the value of lymph node dissection at nephroureterectomy for upper tract urothelial carcinoma. Urology 75(1):118–124. doi:10.1016/j.urology.2009.07.1296 CrossRefPubMed

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 CrossRefPubMed

10.

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 CrossRefPubMed

11.

Ouzzane A, Colin P, Ghoneim TP, Zerbib M, De La Taille A, Audenet F, Saint F, Hoarau N, Adam E, Azemar MD, Bensadoun H, Cormier L, Cussenot O, Houlgatte A, Karsenty G, Maurin C, Nouhaud FX, Phe V, Polguer T, Roumiguie M, Ruffion A, Roupret M (2013) 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 31(1):189–197. doi:10.1007/s00345-012-0983-1 CrossRefPubMed

12.

Zareba P, Rosenzweig B, Winer AG, Coleman JA (2017) Association between lymph node yield and survival among patients undergoing radical nephroureterectomy for urothelial carcinoma of the upper tract. Cancer. doi:10.1002/cncr.30516 PubMed

13.

Winer AG, Vertosick EA, Ghanaat M, Corradi RB, Carlsson S, Sjoberg DD, Sankin AI, Sfakianos JP, Cha EK, Dalbagni G, Coleman JA (2017) Prognostic value of lymph node yield during nephroureterectomy for upper tract urothelial carcinoma. Urol Oncol 35(4):151.e9–151.e15. doi:10.1016/j.urolonc.2016.11.002 CrossRef

14.

Chappidi MR, Kates M, Johnson MH, Hahn NM, Bivalacqua TJ, Pierorazio PM (2016) Lymph node yield and tumor location in patients with upper tract urothelial carcinoma undergoing nephroureterectomy affects survival: A US population-based analysis (2004–2012). Urol Oncol 34(12):531.e15–531.e24. doi:10.1016/j.urolonc.2016.06.013 CrossRef

15.

Roscigno M, Shariat SF, Margulis V, Karakiewicz P, Remzi M, Kikuchi E, Zigeuner R, Weizer A, Sagalowsky A, Bensalah K, Raman JD, Bolenz C, Kassou W, Koppie TM, Wood CG, Wheat J, Langner C, Ng CK, Capitanio U, Bertini R, Fernandez MI, Mikami S, Isida M, Strobel P, Montorsi F (2009) The extent of lymphadenectomy seems to be associated with better survival in patients with nonmetastatic upper-tract urothelial carcinoma: how many lymph nodes should be removed? Eur Urol 56(3):512–518. doi:10.1016/j.eururo.2009.06.004 CrossRefPubMed

16.

Edge SB, Compton CC (2010) The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 17(6):1471–1474. doi:10.1245/s10434-010-0985-4 CrossRefPubMed

17.

Roupret M, Hupertan V, Seisen T, Colin P, Xylinas E, Yates DR, Fajkovic H, Lotan Y, Raman JD, Zigeuner R, Remzi M, Bolenz C, Novara G, Kassouf W, Ouzzane A, Rozet F, Cussenot O, Martinez-Salamanca JI, Fritsche HM, Walton TJ, Wood CG, Bensalah K, Karakiewicz PI, Montorsi F, Margulis V, Shariat SF, French National Database on Upper Tract T, Upper Tract Urothelial Carcinoma C (2013) Prediction of cancer specific survival after radical nephroureterectomy for upper tract urothelial carcinoma: development of an optimized postoperative nomogram using decision curve analysis. J Urol 189(5):1662–1669. doi:10.1016/j.juro.2012.10.057 CrossRefPubMed

18.

Margulis V, Shariat SF, Matin SF, Kamat AM, Zigeuner R, Kikuchi E, Lotan Y, Weizer A, Raman JD, Wood CG, Upper Tract Urothelial Carcinoma Collaboration The Upper Tract Urothelial Carcinoma C (2009) Outcomes of radical nephroureterectomy: a series from the Upper Tract Urothelial Carcinoma Collaboration. Cancer 115(6):1224–1233. doi:10.1002/cncr.24135 CrossRefPubMed

19.

Cha EK, Shariat SF, Kormaksson M, Novara G, Chromecki TF, Scherr DS, Lotan Y, Raman JD, Kassouf W, Zigeuner R, Remzi M, Bensalah K, Weizer A, Kikuchi E, Bolenz C, Roscigno M, Koppie TM, Ng CK, Fritsche HM, Matsumoto K, Walton TJ, Ehdaie B, Tritschler S, Fajkovic H, Martinez-Salamanca JI, Pycha A, Langner C, Ficarra V, Patard JJ, Montorsi F, Wood CG, Karakiewicz PI, Margulis V (2012) Predicting clinical outcomes after radical nephroureterectomy for upper tract urothelial carcinoma. Eur Urol 61(4):818–825. doi:10.1016/j.eururo.2012.01.021 CrossRefPubMed

20.

Jeldres C, Sun M, Lughezzani G, Isbarn H, Shariat SF, Widmer H, Graefen M, Montorsi F, Perrotte P, Karakiewicz PI (2010) Highly predictive survival nomogram after upper urinary tract urothelial carcinoma. Cancer 116(16):3774–3784. doi:10.1002/cncr.25122 CrossRefPubMed

21.

Inokuchi J, Naito S, Fujimoto H, Hara T, Sakura M, Nishiyama H, Miyazaki J, Kikuchi E, Hinotsu S, Koie T, Ohyama C, Cancer Registration Committee of the Japanese Urological A (2015) Impact of multimodal treatment on prognosis for patients with metastatic upper urinary tract urothelial cancer: subanalysis of the multi-institutional nationwide case series study of the Japanese Urological Association. Int J Urol 23(3):224–230. doi:10.1111/iju.13031 CrossRefPubMed

22.

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 CrossRefPubMed

23.

Morgan TM, Kaffenberger SD, Cookson MS (2012) Surgical and chemotherapeutic management of regional lymph nodes in bladder cancer. J Urol 188(4):1081–1088. doi:10.1016/j.juro.2012.06.008 CrossRefPubMed

24.

Kondo T, Hashimoto Y, Kobayashi H, Iizuka J, Nakazawa H, Ito F, Tanabe K (2010) Template-based lymphadenectomy in urothelial carcinoma of the upper urinary tract: impact on patient survival. Int J Urol 17(10):848–854. doi:10.1111/j.1442-2042.2010.02610.x CrossRefPubMed

25.

Kondo T, Hara I, Takagi T, Kodama Y, Hashimoto Y, Kobayashi H, Iizuka J, Omae K, Yoshida K, Tanabe K (2014) Template-based lymphadenectomy in urothelial carcinoma of the renal pelvis: a prospective study. Int J Urol 21(5):453–459. doi:10.1111/iju.12417 CrossRefPubMed

26.

Kondo T, Tanabe K (2012) Role of lymphadenectomy in the management of urothelial carcinoma of the bladder and the upper urinary tract. Int J Urol 19(8):710–721. doi:10.1111/j.1442-2042.2012.03009.x CrossRefPubMed

27.

Matin SF, Sfakianos JP, Espiritu PN, Coleman JA, Spiess PE (2015) Patterns of lymphatic metastases in upper tract urothelial carcinoma and proposed dissection templates. J Urol 194(6):1567–1574. doi:10.1016/j.juro.2015.06.077 CrossRefPubMedPubMedCentral

28.

Leow JJ, Martin-Doyle W, Fay AP, Choueiri TK, Chang SL, Bellmunt J (2014) A systematic review and meta-analysis of adjuvant and neoadjuvant chemotherapy for upper tract urothelial carcinoma. Eur Urol 66(3):529–541. doi:10.1016/j.eururo.2014.03.003 CrossRefPubMed

29.

Seisen T, Krasnow RE, Bellmunt J, Roupret M, Leow JJ, Lipsitz SR, Vetterlein MW, Preston MA, Hanna N, Kibel AS, Sun M, Choueiri TK, Trinh QD, Chang SL (2017) Effectiveness of adjuvant chemotherapy after radical nephroureterectomy for locally advanced and/or positive regional lymph node upper tract urothelial carcinoma. J Clin Oncol 35(8):852–860. doi:10.1200/JCO.2016.69.4141 CrossRefPubMed

30.

Gakis G, Schubert T, Alemozaffar M, Bellmunt J, Bochner BH, Boorjian SA, Daneshmand S, Huang WC, Kondo T, Konety BR, Laguna MP, Matin SF, Siefker-Radtke AO, Shariat SF, Stenzl A (2016) Update of the ICUD-SIU consultation on upper tract urothelial carcinoma 2016: treatment of localized high-risk disease. World J Urol. doi:10.1007/s00345-016-1819-1

Title: Role of lymph node dissection during radical nephroureterectomy for upper urinary tract urothelial cancer: multi-institutional large retrospective study JCOG1110A
Authors: Junichi Inokuchi
Kentaro Kuroiwa
Yoshiyuki Kakehi
Mikio Sugimoto
Toshiki Tanigawa
Hiroyuki Fujimoto
Momokazu Gotoh
Naoya Masumori
Osamu Ogawa
Masatoshi Eto
Chikara Ohyama
Akito Yamaguchi
Hideyasu Matsuyama
Tomohiko Ichikawa
Tomohiko Asano
Junki Mizusawa
Junko Eba
Seiji Naito
Publication date: 01-11-2017
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 11/2017
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-017-2049-x

At a glance: The STEP trials

Springer Medicine

Role of lymph node dissection during radical nephroureterectomy for upper urinary tract urothelial cancer: multi-institutional large retrospective study JCOG1110A

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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