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.
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.
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