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World J Urol. 2017 Nov;35(11):1737-1744. doi: 10.1007/s00345-017-2049-x. Epub 2017 May 15.

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

Author information

1
Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
2
Department of Urology, Miyazaki Prefectural Miyazaki Hospital, 5-30 Kitatakamatsu-cho, Miyazaki, 880-8510, Japan.
3
Department of Urology, Faculty of Medicine, Kagawa University, 1750-1 Oaza Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
4
Department of Urology, Niigata Cancer Center Hospital, 2-15-3 Kawagishimachi, Chuo-ku, Niigata, 951-8566, Japan.
5
Urology Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
6
Department of Urology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, 466-8550, Japan.
7
Department of Urology, Sapporo Medical University School of Medicine, S1W16, Chuo-ku, Sapporo, 060-8543, Japan.
8
Department of Urology, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
9
Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki, 036-8562, Japan.
10
Department of Urology, Harasanshin Hospital, 1-8 Taihakumachi, Hakata-ku, Fukuoka, 812-0033, Japan.
11
Department of Urology, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minami-kogushi, Ube, Yamaguchi, 755-8505, Japan.
12
Department of Urology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
13
Department of Urology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan.
14
JCOG Data Center/Operations Office, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
15
Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. naito@harasanshin.or.jp.
16
Department of Urology, Harasanshin Hospital, 1-8 Taihakumachi, Hakata-ku, Fukuoka, 812-0033, Japan. naito@harasanshin.or.jp.

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.

KEYWORDS:

Japanese; Lymph node dissection; Prognosis; Radical nephroureterectomy; Survival; Upper urinary tract urothelial cancer

PMID:
28508102
DOI:
10.1007/s00345-017-2049-x
[Indexed for MEDLINE]

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