The role of lymph-node dissection in the treatment of upper urinary tract cancer: a multi-institutional study.

Abstract

OBJECTIVES:

To determine the role of lymph-node (LN) dissection in patients undergoing surgery for upper urinary tract (UUT) cancer.

PATIENTS AND METHODS:

We reviewed the clinicopathological data from 312 patients with UUT cancer treated predominantly by nephroureterectomy. The relationship between clinical characteristics and cancer-specific survival (CSS) was analysed, focusing on node-related information.

RESULTS:

In all, 166 patients had LN dissection while 146 did not (pNx). Multivariate analysis showed that T stage, grade and pN status were significant variables for CSS. The difference in survival between the pN0 and pNx groups remained significant in a multivariate analysis. The median (range) number of LNs removed was 6 (1-65). There was no significant difference in CSS between the 72 patients with fewer than six LNs removed and the 78 with six or more removed.

CONCLUSIONS:

LN dissection is important for postoperative stratification of patients with UUT cancer because node-positive disease was one of the variables with a significant adverse effect on survival. In addition, the significant difference in survival between the pN0 and pNx groups might indicate a therapeutic benefit of LN dissection, although removing more LNs did not uniformly increase the probability of CSS.

• Authors: Takashige Abe, Nobuo Shinohara, Toru Harabayashi, Ataru Sazawa, Shuhei Ishikawa, Kanako Kubota, Yoshihiro Matsuno, Takahiro Osawa, Takeshi Shibata, Yuichiro Shinno, Shinji Kamota, Keita Minami, Shigeo Sakashita, Ichiro Takeuchi, Akira Kumagai, Tatsuya Mori, Masaki Togashi, Katsuya Nonomura
• Journal: BJU international (BJU Int) Vol. 102 Issue 5 Pg. 576-80 (Aug 05 2008) ISSN: 1464-410X [Electronic] England
• PMID: 18410428 (Publication Type: Journal Article, Multicenter Study)

Topics

• Adult
• Aged
• Aged, 80 and over
• Female
• Follow-Up Studies
• Humans
• Lymph Node Excision (methods)
• Lymph Nodes (pathology, surgery)
• Lymphatic Metastasis
• Male
• Middle Aged
• Multivariate Analysis
• Neoplasm Staging
• Nephrectomy (methods)
• Retrospective Studies
• Survival Analysis
• Urologic Neoplasms (mortality, secondary, surgery)
• Urothelium (pathology)