TY - JOUR
T1 - Outcomes of Lymph Node Dissection in Nephroureterectomy in the Treatment of Upper Tract Urothelial Carcinoma
T2 - Analysis of the ROBUUST Registry
AU - Hakimi, Kevin
AU - Carbonara, Umberto
AU - Djaladat, Hooman
AU - Mehrazin, Reza
AU - Eun, Daniel
AU - Reese, Adam
AU - Gonzalgo, Mark L.
AU - Margulis, Vitaly
AU - Uzzo, Robert G.
AU - Porter, James
AU - Sundaram, Chandru P.
AU - Abdollah, Firas
AU - Mottrie, Alexandre
AU - Tellini, Riccardo
AU - Ferro, Matteo
AU - Walia, Arman
AU - Saidian, Ava
AU - Soliman, Shady
AU - Yuan, Julia
AU - Veccia, Alessandro
AU - Ghoreifi, Alireza
AU - Cacciamani, Giovanni
AU - Bhattu, Amit S.
AU - Meng, Xiaosong
AU - Farrow, Jason M.
AU - Jamil, Marcus
AU - Minervini, Andrea
AU - Rha, Koon H.
AU - Wu, Zhenjie
AU - Simone, Giuseppe
AU - Autorino, Riccardo
AU - Derweesh, Ithaar H.
N1 - Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/8/1
Y1 - 2022/8/1
N2 - Purpose:We sought to evaluate outcomes of lymph node dissection (LND) in patients with upper tract urothelial carcinoma.Materials and Methods:We performed a multicenter retrospective analysis utilizing the ROBUUST (for RObotic surgery for Upper Tract Urothelial Cancer Study) registry for patients who did not undergo LND (pNx), LND with negative lymph nodes (pN0) and LND with positive nodes (pN+). Primary and secondary outcomes were overall survival (OS) and recurrence-free survival (RFS). Multivariable analyses evaluated predictors of outcomes and pathological node positivity. Kaplan-Meier analyses (KMAs) compared survival outcomes.Results:A total of 877 patients were analyzed (LND performed in 358 [40.8%]/pN+ in 73 [8.3%]). Median nodes obtained were 10.2 for pN+ and 9.8 for pN0. Multivariable analyses noted increasing age (OR 1.1, p <0.001), pN+ (OR 3.1, p <0.001) and pathological stage pTis/3/4 (OR 3.4, p <0.001) as predictors for all-cause mortality. Clinical high-grade tumors (OR 11.74, p=0.015) and increasing tumor size (OR 1.14, p=0.001) were predictive for lymph node positivity. KMAs for pNx, pN0 and pN+ demonstrated 2-year OS of 80%, 86% and 42% (p <0.001) and 2-year RFS of 53%, 61% and 35% (p <0.001), respectively. KMAs comparing pNx, pN0 ≥10 nodes and pN0 <10 nodes showed no significant difference in 2-year OS (82% vs 85% vs 84%, p=0.6) but elicited significantly higher 2-year RFS in the pN0 ≥10 group (60% vs 74% vs 54%, p=0.043).Conclusions:LND during nephroureterectomy in patients with positive lymph nodes provides prognostic data, but is not associated with improved OS. LND yields ≥10 in patients with clinical node negative disease were associated with improved RFS. In high-grade and large tumors, lymphadenectomy should be considered.
AB - Purpose:We sought to evaluate outcomes of lymph node dissection (LND) in patients with upper tract urothelial carcinoma.Materials and Methods:We performed a multicenter retrospective analysis utilizing the ROBUUST (for RObotic surgery for Upper Tract Urothelial Cancer Study) registry for patients who did not undergo LND (pNx), LND with negative lymph nodes (pN0) and LND with positive nodes (pN+). Primary and secondary outcomes were overall survival (OS) and recurrence-free survival (RFS). Multivariable analyses evaluated predictors of outcomes and pathological node positivity. Kaplan-Meier analyses (KMAs) compared survival outcomes.Results:A total of 877 patients were analyzed (LND performed in 358 [40.8%]/pN+ in 73 [8.3%]). Median nodes obtained were 10.2 for pN+ and 9.8 for pN0. Multivariable analyses noted increasing age (OR 1.1, p <0.001), pN+ (OR 3.1, p <0.001) and pathological stage pTis/3/4 (OR 3.4, p <0.001) as predictors for all-cause mortality. Clinical high-grade tumors (OR 11.74, p=0.015) and increasing tumor size (OR 1.14, p=0.001) were predictive for lymph node positivity. KMAs for pNx, pN0 and pN+ demonstrated 2-year OS of 80%, 86% and 42% (p <0.001) and 2-year RFS of 53%, 61% and 35% (p <0.001), respectively. KMAs comparing pNx, pN0 ≥10 nodes and pN0 <10 nodes showed no significant difference in 2-year OS (82% vs 85% vs 84%, p=0.6) but elicited significantly higher 2-year RFS in the pN0 ≥10 group (60% vs 74% vs 54%, p=0.043).Conclusions:LND during nephroureterectomy in patients with positive lymph nodes provides prognostic data, but is not associated with improved OS. LND yields ≥10 in patients with clinical node negative disease were associated with improved RFS. In high-grade and large tumors, lymphadenectomy should be considered.
KW - Carcinoma, Transitional Cell/surgery
KW - Humans
KW - Lymph Node Excision
KW - Nephroureterectomy
KW - Registries
KW - Retrospective Studies
KW - Treatment Outcome
KW - Urinary Bladder Neoplasms/surgery
UR - http://www.scopus.com/inward/record.url?scp=85134350271&partnerID=8YFLogxK
UR - https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=purepublist2023&SrcAuth=WosAPI&KeyUT=WOS:000823292100015&DestLinkType=FullRecord&DestApp=WOS
U2 - 10.1097/JU.0000000000002690
DO - 10.1097/JU.0000000000002690
M3 - Article
C2 - 35377778
SN - 0022-5347
VL - 208
SP - 268
EP - 276
JO - Journal of Urology
JF - Journal of Urology
IS - 2
ER -