Patients with nonmetastatic stage 3 to 4 upper tract urothelial carcinoma (UTUC) may benefit from lymph node dissection, new study findings suggest. Whether stage 1 to 2 patients also benefit from the procedure remains unclear.

Of 7278 patients with UTUC undergoing nephroureterectomy (median age 73 years; 59% male) within the Surveillance, Epidemiology, and End Results (SEER) database 2004 to 2015, 26.9% underwent lymphadenectomy, Ting-Shuai Zhai, MBBS, MS, of Shanghai Tenth People’s Hospital of Tongji University in Shanghai, China, and colleagues reported in BMC Nephrology. The lymphadenectomy group included 18.6%, 23.3%, 31.2%, and 45.9% of patients with pT1, pT2, pT3, and pT4 tumors, respectively. Overall, 56.5% underwent limited dissection (1-3 regional nodes) and 43.5% had extended dissection (4 or more regional nodes).

Lymph node dissection use increased from 2004 to 2015, the team reported. Urologists performed significantly more dissections in younger, non-white patients with left laterality and larger tumors (more than 2 cm) of higher grade and advanced stage. Lymph node metastasis was found in 12.2%, 20.3%, 39.4%, and 65.3% of patients with pT1, pT2, pT3, and pT4 tumors, respectively, and 19.8%, 86.5%, 93.4%, and 85.0% of patients with N0, N1, N2, and N3 disease, respectively. The findings confirmed that patients had advanced stage UTUC.

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In multivariable Cox regression analyses, lymphadenectomy was significantly associated with improved overall survival (OS) and cancer-specific survival (CSS) in patients with pT3 and pT4 UTUC. Extended dissection of 4 or more regional lymph nodes correlated with significantly higher 5- and 10-year OS and CS in these patients compared with no lymphadenectomy. Stage 4 patients appeared to benefit more from a limited dissection of 1 to 3 nodes than an extended dissection, however, perhaps due to the higher risk of severe complications from the latter procedure. Overall, 17.3% patients received adjuvant chemotherapy.

Lymphadenectomy should be considered in locally advanced UTUC patients, Dr Zhai’s team concluded. To what degree lymph node dissection might benefit stage 1 to 2 UTUC patients requires further research, they stated.

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Zhai TS, Jin L, Zhou Z, et al. Effect of lymph node dissection on stage-specific survival in patients with upper urinary tract urothelial carcinoma treated with nephroureterectomy. BMC Cancer 2019;19:1207. doi:10.1186/s12885-019-6364-z