Assessment of the Minimum Number of Lymph Nodes Needed to Detect Lymph Node Invasion at Radical Nephroureterectomy in Patients With Upper Tract Urothelial Cancer

Marco Roscigno, Shahrokh F. Shariat, Massimo Freschi, Vitaly Margulis, Pierre Karakiewizc, Nazareno Suardi, Mesut Remzi, Richard Zigeuner, Christian Bolenz, Eiji Kikuchi, Alon Weizer, Karim Bensalah, Arthur Sagalowsky, Theresa M. Koppie, Jay Raman, Mario Fernández, Philipp Ströbel, Wareef Kabbani, Cord Langner, Jeffery WheatCharles C. Guo, Wassim Kassouf, Andrea Haitel, Christopher G. Wood, Francesco Montorsi

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Abstract

Objectives: To determine whether a minimum number of lymph nodes (LNs) exist to detect lymph node invasion (LNI) in patients undergoing radical nephroureterectomy (RNU) for upper tract urothelial carcinoma. Methods: The study included 551 consecutive patients, from 13 centers worldwide, who underwent RNU and lymphadenectomy (LND) between 1992 and 2006. LND was performed at the discretion of the surgeon. All pathological slides were re-reviewed by uropathologists according to strict criteria. Receiver-operating characteristic curve coordinates were used to determine the probability of diagnosing LNI according to the total number of nodes removed. Additionally, the relationship between the number of nodes removed and the rate of positive LNs was tested in univariate and multivariate logistic regression models. Results: Median patient age was 68 years (range: 27-97). Of 551 patients, 140 (25.4%) had positive lymph nodes. Median number of lymph nodes removed was 5 (mean 6.7, range 1-41). The Receiver-operating characteristic coordinates plot indicated that the removal of 13 nodes yielded a 90% probability to detect ≥1 positive LNs. The removal of 8 nodes resulted in a 75% probability of finding ≥1 positive nodes. Removal of >8 LNs (P = .03; odds ratio 1.49) was independently associated with LNI after adjusting for pathological stage and grade. Conclusions: Our data indicate that 8 LNs need to be removed at radical nephroureterectomy to achieve a 75% probability of finding ≥1 positive nodes. Further improvement of the specificity of LND will require the removal of more lymph nodes.

Original languageEnglish
Pages (from-to)1070-1074
Number of pages5
JournalUrology
Volume74
Issue number5
DOIs
Publication statusPublished - 2009 Nov

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Lymph Nodes
Neoplasms
ROC Curve
Logistic Models
Lymph Node Excision
Odds Ratio
Carcinoma

ASJC Scopus subject areas

  • Urology

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Assessment of the Minimum Number of Lymph Nodes Needed to Detect Lymph Node Invasion at Radical Nephroureterectomy in Patients With Upper Tract Urothelial Cancer. / Roscigno, Marco; Shariat, Shahrokh F.; Freschi, Massimo; Margulis, Vitaly; Karakiewizc, Pierre; Suardi, Nazareno; Remzi, Mesut; Zigeuner, Richard; Bolenz, Christian; Kikuchi, Eiji; Weizer, Alon; Bensalah, Karim; Sagalowsky, Arthur; Koppie, Theresa M.; Raman, Jay; Fernández, Mario; Ströbel, Philipp; Kabbani, Wareef; Langner, Cord; Wheat, Jeffery; Guo, Charles C.; Kassouf, Wassim; Haitel, Andrea; Wood, Christopher G.; Montorsi, Francesco.

In: Urology, Vol. 74, No. 5, 11.2009, p. 1070-1074.

Research output: Contribution to journalArticle

Roscigno, M, Shariat, SF, Freschi, M, Margulis, V, Karakiewizc, P, Suardi, N, Remzi, M, Zigeuner, R, Bolenz, C, Kikuchi, E, Weizer, A, Bensalah, K, Sagalowsky, A, Koppie, TM, Raman, J, Fernández, M, Ströbel, P, Kabbani, W, Langner, C, Wheat, J, Guo, CC, Kassouf, W, Haitel, A, Wood, CG & Montorsi, F 2009, 'Assessment of the Minimum Number of Lymph Nodes Needed to Detect Lymph Node Invasion at Radical Nephroureterectomy in Patients With Upper Tract Urothelial Cancer', Urology, vol. 74, no. 5, pp. 1070-1074. https://doi.org/10.1016/j.urology.2009.04.084
Roscigno, Marco ; Shariat, Shahrokh F. ; Freschi, Massimo ; Margulis, Vitaly ; Karakiewizc, Pierre ; Suardi, Nazareno ; Remzi, Mesut ; Zigeuner, Richard ; Bolenz, Christian ; Kikuchi, Eiji ; Weizer, Alon ; Bensalah, Karim ; Sagalowsky, Arthur ; Koppie, Theresa M. ; Raman, Jay ; Fernández, Mario ; Ströbel, Philipp ; Kabbani, Wareef ; Langner, Cord ; Wheat, Jeffery ; Guo, Charles C. ; Kassouf, Wassim ; Haitel, Andrea ; Wood, Christopher G. ; Montorsi, Francesco. / Assessment of the Minimum Number of Lymph Nodes Needed to Detect Lymph Node Invasion at Radical Nephroureterectomy in Patients With Upper Tract Urothelial Cancer. In: Urology. 2009 ; Vol. 74, No. 5. pp. 1070-1074.
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abstract = "Objectives: To determine whether a minimum number of lymph nodes (LNs) exist to detect lymph node invasion (LNI) in patients undergoing radical nephroureterectomy (RNU) for upper tract urothelial carcinoma. Methods: The study included 551 consecutive patients, from 13 centers worldwide, who underwent RNU and lymphadenectomy (LND) between 1992 and 2006. LND was performed at the discretion of the surgeon. All pathological slides were re-reviewed by uropathologists according to strict criteria. Receiver-operating characteristic curve coordinates were used to determine the probability of diagnosing LNI according to the total number of nodes removed. Additionally, the relationship between the number of nodes removed and the rate of positive LNs was tested in univariate and multivariate logistic regression models. Results: Median patient age was 68 years (range: 27-97). Of 551 patients, 140 (25.4{\%}) had positive lymph nodes. Median number of lymph nodes removed was 5 (mean 6.7, range 1-41). The Receiver-operating characteristic coordinates plot indicated that the removal of 13 nodes yielded a 90{\%} probability to detect ≥1 positive LNs. The removal of 8 nodes resulted in a 75{\%} probability of finding ≥1 positive nodes. Removal of >8 LNs (P = .03; odds ratio 1.49) was independently associated with LNI after adjusting for pathological stage and grade. Conclusions: Our data indicate that 8 LNs need to be removed at radical nephroureterectomy to achieve a 75{\%} probability of finding ≥1 positive nodes. Further improvement of the specificity of LND will require the removal of more lymph nodes.",
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AU - Roscigno, Marco

AU - Shariat, Shahrokh F.

AU - Freschi, Massimo

AU - Margulis, Vitaly

AU - Karakiewizc, Pierre

AU - Suardi, Nazareno

AU - Remzi, Mesut

AU - Zigeuner, Richard

AU - Bolenz, Christian

AU - Kikuchi, Eiji

AU - Weizer, Alon

AU - Bensalah, Karim

AU - Sagalowsky, Arthur

AU - Koppie, Theresa M.

AU - Raman, Jay

AU - Fernández, Mario

AU - Ströbel, Philipp

AU - Kabbani, Wareef

AU - Langner, Cord

AU - Wheat, Jeffery

AU - Guo, Charles C.

AU - Kassouf, Wassim

AU - Haitel, Andrea

AU - Wood, Christopher G.

AU - Montorsi, Francesco

PY - 2009/11

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N2 - Objectives: To determine whether a minimum number of lymph nodes (LNs) exist to detect lymph node invasion (LNI) in patients undergoing radical nephroureterectomy (RNU) for upper tract urothelial carcinoma. Methods: The study included 551 consecutive patients, from 13 centers worldwide, who underwent RNU and lymphadenectomy (LND) between 1992 and 2006. LND was performed at the discretion of the surgeon. All pathological slides were re-reviewed by uropathologists according to strict criteria. Receiver-operating characteristic curve coordinates were used to determine the probability of diagnosing LNI according to the total number of nodes removed. Additionally, the relationship between the number of nodes removed and the rate of positive LNs was tested in univariate and multivariate logistic regression models. Results: Median patient age was 68 years (range: 27-97). Of 551 patients, 140 (25.4%) had positive lymph nodes. Median number of lymph nodes removed was 5 (mean 6.7, range 1-41). The Receiver-operating characteristic coordinates plot indicated that the removal of 13 nodes yielded a 90% probability to detect ≥1 positive LNs. The removal of 8 nodes resulted in a 75% probability of finding ≥1 positive nodes. Removal of >8 LNs (P = .03; odds ratio 1.49) was independently associated with LNI after adjusting for pathological stage and grade. Conclusions: Our data indicate that 8 LNs need to be removed at radical nephroureterectomy to achieve a 75% probability of finding ≥1 positive nodes. Further improvement of the specificity of LND will require the removal of more lymph nodes.

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