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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

verfasst von: 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

Erschienen in: World Journal of Urology | Ausgabe 1/2013

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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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Titel: The impact of lymph node status and features on oncological outcomes in urothelial carcinoma of the upper urinary tract (UTUC) treated by nephroureterectomy
verfasst von: 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
Publikationsdatum: 01.02.2013
Verlag: Springer-Verlag
Erschienen in: World Journal of Urology / Ausgabe 1/2013
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-012-0983-1

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