Risk stratification of patients with nodal involvement in upper tract urothelial carcinoma

Value of lymph-node density

Christian Bolenz, Shahrokh F. Shariat, Mario I. Fernández, Vitaly Margulis, Yair Lotan, Pierre Karakiewicz, Mesut Remzi, Eiji Kikuchi, Richard Zigeuner, Alon Weizer, Francesco Montorsi, Karim Bensalah, Christopher G. Wood, Marco Roscigno, Cord Langner, Theresa M. Koppie, Jay D. Raman, Shuji Mikami, Maurice Stephan Michel, Philipp Ströbel

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

OBJECTIVE: To determine the risk factors associated with clinical outcome in patients with lymph node (LN)-positive urothelial carcinoma of the upper urinary tract (UTUC) treated with radical nephroureterectomy (RNU) and lymphadenectomy, focusing on the concept of LN density (LND). PATIENTS AND METHODS: Patients undergoing RNU with regional lymphadenectomy were identified through multi-institutional databases. All pathology slides were re-evaluated by genitourinary pathologists unaware of the clinical data. The exposure variable used was LND (continuously coded and that of all possible thresholds) with recurrence-free and disease-specific survival (DSS) serving as the outcome measures. RESULTS: Of 432 patients undergoing RNU with lymphadenectomy, 135 (31%) had LN metastases. Within a median follow-up of 4.1 years, 90 of the 135 patients with LN metastases (68%) had disease recurrence and 76 (58%) died from UTUC. The mean (sem) 5-year recurrence-free and DSS probabilities were 27 (4)% and 33 (5)%, respectively. The median (range) LND was 50 (3-100)%. The most informative threshold for LND in relation to outcome was 30%. In multivariable analyses that adjusted for the effects of tumour stage and grade, patients with a LND of ≥30% were at greater risk of both cancer recurrence, with 5-year rates of 25 (5)% vs 38 (8)% (hazard ratio 1.8, P = 0.021) and mortality, with 5-year rates of 30 (6)% vs 48 (9)% (1.7, P = 0.032) compared to those with a LND of <30%. Our results are primarily limited by a lack of standardization in the lymphadenectomy template. CONCLUSION: We evaluated the concept of LND for the first time in UTUC. LND provides additional prognostic information in patients with node-positive disease after RNU. The use of LND in clinical trials might provide an additional insight into the value of LN dissection in patients undergoing RNU.

Original languageEnglish
Pages (from-to)302-306
Number of pages5
JournalBJU International
Volume103
Issue number3
DOIs
Publication statusPublished - 2009 Feb

Fingerprint

Lymph Nodes
Lymph Node Excision
Carcinoma
Recurrence
Disease-Free Survival
Neoplasm Metastasis
Urinary Tract
Neoplasms
Outcome Assessment (Health Care)
Clinical Trials
Databases
Pathology
Mortality

Keywords

  • Lymph node dissection
  • Lymphatic metastases
  • Prognosis
  • Urinary tract cancer
  • Urothelial carcinoma

ASJC Scopus subject areas

  • Urology

Cite this

Bolenz, C., Shariat, S. F., Fernández, M. I., Margulis, V., Lotan, Y., Karakiewicz, P., ... Ströbel, P. (2009). Risk stratification of patients with nodal involvement in upper tract urothelial carcinoma: Value of lymph-node density. BJU International, 103(3), 302-306. https://doi.org/10.1111/j.1464-410X.2008.07988.x

Risk stratification of patients with nodal involvement in upper tract urothelial carcinoma : Value of lymph-node density. / Bolenz, Christian; Shariat, Shahrokh F.; Fernández, Mario I.; Margulis, Vitaly; Lotan, Yair; Karakiewicz, Pierre; Remzi, Mesut; Kikuchi, Eiji; Zigeuner, Richard; Weizer, Alon; Montorsi, Francesco; Bensalah, Karim; Wood, Christopher G.; Roscigno, Marco; Langner, Cord; Koppie, Theresa M.; Raman, Jay D.; Mikami, Shuji; Michel, Maurice Stephan; Ströbel, Philipp.

In: BJU International, Vol. 103, No. 3, 02.2009, p. 302-306.

Research output: Contribution to journalArticle

Bolenz, C, Shariat, SF, Fernández, MI, Margulis, V, Lotan, Y, Karakiewicz, P, Remzi, M, Kikuchi, E, Zigeuner, R, Weizer, A, Montorsi, F, Bensalah, K, Wood, CG, Roscigno, M, Langner, C, Koppie, TM, Raman, JD, Mikami, S, Michel, MS & Ströbel, P 2009, 'Risk stratification of patients with nodal involvement in upper tract urothelial carcinoma: Value of lymph-node density', BJU International, vol. 103, no. 3, pp. 302-306. https://doi.org/10.1111/j.1464-410X.2008.07988.x
Bolenz, Christian ; Shariat, Shahrokh F. ; Fernández, Mario I. ; Margulis, Vitaly ; Lotan, Yair ; Karakiewicz, Pierre ; Remzi, Mesut ; Kikuchi, Eiji ; Zigeuner, Richard ; Weizer, Alon ; Montorsi, Francesco ; Bensalah, Karim ; Wood, Christopher G. ; Roscigno, Marco ; Langner, Cord ; Koppie, Theresa M. ; Raman, Jay D. ; Mikami, Shuji ; Michel, Maurice Stephan ; Ströbel, Philipp. / Risk stratification of patients with nodal involvement in upper tract urothelial carcinoma : Value of lymph-node density. In: BJU International. 2009 ; Vol. 103, No. 3. pp. 302-306.
@article{89a1550059e8440585c790b4e197bada,
title = "Risk stratification of patients with nodal involvement in upper tract urothelial carcinoma: Value of lymph-node density",
abstract = "OBJECTIVE: To determine the risk factors associated with clinical outcome in patients with lymph node (LN)-positive urothelial carcinoma of the upper urinary tract (UTUC) treated with radical nephroureterectomy (RNU) and lymphadenectomy, focusing on the concept of LN density (LND). PATIENTS AND METHODS: Patients undergoing RNU with regional lymphadenectomy were identified through multi-institutional databases. All pathology slides were re-evaluated by genitourinary pathologists unaware of the clinical data. The exposure variable used was LND (continuously coded and that of all possible thresholds) with recurrence-free and disease-specific survival (DSS) serving as the outcome measures. RESULTS: Of 432 patients undergoing RNU with lymphadenectomy, 135 (31{\%}) had LN metastases. Within a median follow-up of 4.1 years, 90 of the 135 patients with LN metastases (68{\%}) had disease recurrence and 76 (58{\%}) died from UTUC. The mean (sem) 5-year recurrence-free and DSS probabilities were 27 (4){\%} and 33 (5){\%}, respectively. The median (range) LND was 50 (3-100){\%}. The most informative threshold for LND in relation to outcome was 30{\%}. In multivariable analyses that adjusted for the effects of tumour stage and grade, patients with a LND of ≥30{\%} were at greater risk of both cancer recurrence, with 5-year rates of 25 (5){\%} vs 38 (8){\%} (hazard ratio 1.8, P = 0.021) and mortality, with 5-year rates of 30 (6){\%} vs 48 (9){\%} (1.7, P = 0.032) compared to those with a LND of <30{\%}. Our results are primarily limited by a lack of standardization in the lymphadenectomy template. CONCLUSION: We evaluated the concept of LND for the first time in UTUC. LND provides additional prognostic information in patients with node-positive disease after RNU. The use of LND in clinical trials might provide an additional insight into the value of LN dissection in patients undergoing RNU.",
keywords = "Lymph node dissection, Lymphatic metastases, Prognosis, Urinary tract cancer, Urothelial carcinoma",
author = "Christian Bolenz and Shariat, {Shahrokh F.} and Fern{\'a}ndez, {Mario I.} and Vitaly Margulis and Yair Lotan and Pierre Karakiewicz and Mesut Remzi and Eiji Kikuchi and Richard Zigeuner and Alon Weizer and Francesco Montorsi and Karim Bensalah and Wood, {Christopher G.} and Marco Roscigno and Cord Langner and Koppie, {Theresa M.} and Raman, {Jay D.} and Shuji Mikami and Michel, {Maurice Stephan} and Philipp Str{\"o}bel",
year = "2009",
month = "2",
doi = "10.1111/j.1464-410X.2008.07988.x",
language = "English",
volume = "103",
pages = "302--306",
journal = "BJU International",
issn = "1464-4096",
publisher = "Wiley-Blackwell",
number = "3",

}

TY - JOUR

T1 - Risk stratification of patients with nodal involvement in upper tract urothelial carcinoma

T2 - Value of lymph-node density

AU - Bolenz, Christian

AU - Shariat, Shahrokh F.

AU - Fernández, Mario I.

AU - Margulis, Vitaly

AU - Lotan, Yair

AU - Karakiewicz, Pierre

AU - Remzi, Mesut

AU - Kikuchi, Eiji

AU - Zigeuner, Richard

AU - Weizer, Alon

AU - Montorsi, Francesco

AU - Bensalah, Karim

AU - Wood, Christopher G.

AU - Roscigno, Marco

AU - Langner, Cord

AU - Koppie, Theresa M.

AU - Raman, Jay D.

AU - Mikami, Shuji

AU - Michel, Maurice Stephan

AU - Ströbel, Philipp

PY - 2009/2

Y1 - 2009/2

N2 - OBJECTIVE: To determine the risk factors associated with clinical outcome in patients with lymph node (LN)-positive urothelial carcinoma of the upper urinary tract (UTUC) treated with radical nephroureterectomy (RNU) and lymphadenectomy, focusing on the concept of LN density (LND). PATIENTS AND METHODS: Patients undergoing RNU with regional lymphadenectomy were identified through multi-institutional databases. All pathology slides were re-evaluated by genitourinary pathologists unaware of the clinical data. The exposure variable used was LND (continuously coded and that of all possible thresholds) with recurrence-free and disease-specific survival (DSS) serving as the outcome measures. RESULTS: Of 432 patients undergoing RNU with lymphadenectomy, 135 (31%) had LN metastases. Within a median follow-up of 4.1 years, 90 of the 135 patients with LN metastases (68%) had disease recurrence and 76 (58%) died from UTUC. The mean (sem) 5-year recurrence-free and DSS probabilities were 27 (4)% and 33 (5)%, respectively. The median (range) LND was 50 (3-100)%. The most informative threshold for LND in relation to outcome was 30%. In multivariable analyses that adjusted for the effects of tumour stage and grade, patients with a LND of ≥30% were at greater risk of both cancer recurrence, with 5-year rates of 25 (5)% vs 38 (8)% (hazard ratio 1.8, P = 0.021) and mortality, with 5-year rates of 30 (6)% vs 48 (9)% (1.7, P = 0.032) compared to those with a LND of <30%. Our results are primarily limited by a lack of standardization in the lymphadenectomy template. CONCLUSION: We evaluated the concept of LND for the first time in UTUC. LND provides additional prognostic information in patients with node-positive disease after RNU. The use of LND in clinical trials might provide an additional insight into the value of LN dissection in patients undergoing RNU.

AB - OBJECTIVE: To determine the risk factors associated with clinical outcome in patients with lymph node (LN)-positive urothelial carcinoma of the upper urinary tract (UTUC) treated with radical nephroureterectomy (RNU) and lymphadenectomy, focusing on the concept of LN density (LND). PATIENTS AND METHODS: Patients undergoing RNU with regional lymphadenectomy were identified through multi-institutional databases. All pathology slides were re-evaluated by genitourinary pathologists unaware of the clinical data. The exposure variable used was LND (continuously coded and that of all possible thresholds) with recurrence-free and disease-specific survival (DSS) serving as the outcome measures. RESULTS: Of 432 patients undergoing RNU with lymphadenectomy, 135 (31%) had LN metastases. Within a median follow-up of 4.1 years, 90 of the 135 patients with LN metastases (68%) had disease recurrence and 76 (58%) died from UTUC. The mean (sem) 5-year recurrence-free and DSS probabilities were 27 (4)% and 33 (5)%, respectively. The median (range) LND was 50 (3-100)%. The most informative threshold for LND in relation to outcome was 30%. In multivariable analyses that adjusted for the effects of tumour stage and grade, patients with a LND of ≥30% were at greater risk of both cancer recurrence, with 5-year rates of 25 (5)% vs 38 (8)% (hazard ratio 1.8, P = 0.021) and mortality, with 5-year rates of 30 (6)% vs 48 (9)% (1.7, P = 0.032) compared to those with a LND of <30%. Our results are primarily limited by a lack of standardization in the lymphadenectomy template. CONCLUSION: We evaluated the concept of LND for the first time in UTUC. LND provides additional prognostic information in patients with node-positive disease after RNU. The use of LND in clinical trials might provide an additional insight into the value of LN dissection in patients undergoing RNU.

KW - Lymph node dissection

KW - Lymphatic metastases

KW - Prognosis

KW - Urinary tract cancer

KW - Urothelial carcinoma

UR - http://www.scopus.com/inward/record.url?scp=58449135464&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=58449135464&partnerID=8YFLogxK

U2 - 10.1111/j.1464-410X.2008.07988.x

DO - 10.1111/j.1464-410X.2008.07988.x

M3 - Article

VL - 103

SP - 302

EP - 306

JO - BJU International

JF - BJU International

SN - 1464-4096

IS - 3

ER -