Isolated lymph node involvement in patients with upper tract urothelial carcinoma (UTUC) is associated with poor long-term survival following surgical resection, according to investigators. Older age, larger tumor size, and positive surgical margins are among the independent risk factors for worse survival, a team led by Boris Gershman, MD, of Beth Israel Deaconess Medical Center and Harvard Medical School in Boston, reported in the World Journal of Urology.
In a study of 794 patients aged 18 to 89 years who underwent radical nephroureterectomy with lymph node dissection for nonmetastatic UTUC with lymph node involvement, Dr Gershman and his colleagues found that patients had 1-, 5-, and 8-year overall survival rates of 63.7%, 24.2%, and 18.7%, respectively.
The median follow-up period among survivors was 39.5 months, during which 555 patients (70%) died.
On multivariable analysis, patients aged 60 to 79 years and 80 years or older had 93% and 51% increased risks of death compared with those younger than 60 years. Patients with pT4 tumors had a significant 3.8-fold increased risk of death compared with those who had the pT1 tumors. Patients with tumors larger than 10 cm had a significant 55% increased risk of death compared with those who had 5 cm tumors or smaller. Positive surgical margins were associated with a significant 33% increased risk of death compared with negative surgical margins. Patients with more than 2 positive lymph nodes had a significant 35% increased risk of death compared with those who had 1 positive lymph node.
Based on these risk factors, Dr Gershman and his collaborators from Brown University in Providence, Rhode Island, and University of Colorado Anschutz Medical Center in Aurora, constructed a risk score for predicting survival, with points added for each feature (1 point each for age 60-79 and 80 years or more, tumor size greater than 10 cm, the presence of more than 2 positive lymph nodes, pT3 tumors, and positive surgical margins, and 2 points for pT4 tumors). The predicted probabilities of 5-year overall survival were 44%, 16%, and 12% for risk scores of 2 or less, 3, and 4 or more points, respectively.
The study also found that patients who received adjuvant chemotherapy had a significant 46% decreased risk of death compared with those who did not. “Although adjuvant chemotherapy appears to be associated with improved survival in UTUC, utilization rates of neoadjuvant chemotherapy remain low in this patient population,” the authors concluded. “Clinicopathologic predictors of poor survival after surgical resection may improve risk-stratification, counseling, and selection of patients for multimodal management.”
Pelcovits A, Mueller-Leonhard C, Mega A, et al. Outcomes of upper tract urothelial carcinoma with isolated lymph node involvement following surgical resection: implications for multi-modal management. World J Urol. 2019. doi: 10.1007/s00345-019-02897-2