The Extent of Lymphadenectomy Seems to Be Associated with Better Survival in Patients with Nonmetastatic Upper-Tract Urothelial Carcinoma

How Many Lymph Nodes Should Be Removed?

Marco Roscigno, Shahrokh F. Shariat, Vitaly Margulis, Pierre Karakiewicz, Mesut Remzi, Eiji Kikuchi, Richard Zigeuner, Alon Weizer, Arthur Sagalowsky, Karim Bensalah, Jay D. Raman, Christian Bolenz, Wassim Kassou, Theresa M. Koppie, Christopher G. Wood, Jeffrey Wheat, Cord Langner, Casey K. Ng, Umberto Capitanio, Roberto Bertini & 5 others Mario I. Fernández, Shuji Mikami, Masaru Isida, Philipp Ströbel, Francesco Montorsi

Research output: Contribution to journalArticle

111 Citations (Scopus)

Abstract

Background: The role and extent of lymphadenectomy in patients with upper-tract urothelial carcinoma (UTUC) is debated. Objective: To establish whether the number of lymph nodes (LNs) removed might be associated with better cause-specific survival in patients with UTUC. Design, setting, and participants: The study included 552 consecutive patients who underwent radical nephroureterectomy (RNU) and lymphadenectomy between 1992 and 2006. Intervention: Patients were treated with RNU and lymphadenectomy. Measurements: Univariable and multivariable Cox proportional hazards regression models addressed the association between the number of LNs removed and cause-specific mortality (CSM). The number of LNs removed was coded as a cubic spline to allow for nonlinear effects. Finally, the most informative cut-off for the number of removed LNs was identified. Results and limitations: In the entire population, the number of LNs removed was not associated with CSM in univariable (hazard ratio [HR]: 0.99; p = 0.16) or in multivariable (HR: 0.97; p = 0.12) analyses. In contrast, in the subgroup of pN0 patients (n = 412), the number of LNs removed achieved the independent predictor status of CSM (HR: 0.93; p = 0.02). Eight LNs removed was the most informative cut-off in predicting CSM (HR: 0.42; p = 0.004). The inclusion of the variable defining dichotomously the number of removed LNs (<8 vs ≥8) in the base model (age, Eastern Cooperative Oncology Group performance status, pathologic stage, grade, architecture, and lymphovascular invasion) significantly increased the accuracy in predicting CSM (+1.7%; p < 0.001). Conclusions: The extension of the lymphadenectomy in pN0 UTUC patients seems to be associated with CSM. Longer survival was observed in patients in whom at least eight LNs had been removed.

Original languageEnglish
Pages (from-to)512-519
Number of pages8
JournalEuropean Urology
Volume56
Issue number3
DOIs
Publication statusPublished - 2009 Sep

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Lymph Node Excision
Lymph Nodes
Carcinoma
Survival
Mortality
Proportional Hazards Models
Population

Keywords

  • Lymph node dissection
  • Metastasis
  • Nephroureterectomy
  • Prognosis
  • Survival
  • Urinary tract cancer
  • Urothelial carcinoma

ASJC Scopus subject areas

  • Urology

Cite this

The Extent of Lymphadenectomy Seems to Be Associated with Better Survival in Patients with Nonmetastatic Upper-Tract Urothelial Carcinoma : How Many Lymph Nodes Should Be Removed? / Roscigno, Marco; Shariat, Shahrokh F.; Margulis, Vitaly; Karakiewicz, Pierre; Remzi, Mesut; Kikuchi, Eiji; Zigeuner, Richard; Weizer, Alon; Sagalowsky, Arthur; Bensalah, Karim; Raman, Jay D.; Bolenz, Christian; Kassou, Wassim; Koppie, Theresa M.; Wood, Christopher G.; Wheat, Jeffrey; Langner, Cord; Ng, Casey K.; Capitanio, Umberto; Bertini, Roberto; Fernández, Mario I.; Mikami, Shuji; Isida, Masaru; Ströbel, Philipp; Montorsi, Francesco.

In: European Urology, Vol. 56, No. 3, 09.2009, p. 512-519.

Research output: Contribution to journalArticle

Roscigno, M, Shariat, SF, Margulis, V, Karakiewicz, P, Remzi, M, Kikuchi, E, Zigeuner, R, Weizer, A, Sagalowsky, A, Bensalah, K, Raman, JD, Bolenz, C, Kassou, W, Koppie, TM, Wood, CG, Wheat, J, Langner, C, Ng, CK, Capitanio, U, Bertini, R, Fernández, MI, Mikami, S, Isida, M, Ströbel, P & Montorsi, F 2009, 'The Extent of Lymphadenectomy Seems to Be Associated with Better Survival in Patients with Nonmetastatic Upper-Tract Urothelial Carcinoma: How Many Lymph Nodes Should Be Removed?', European Urology, vol. 56, no. 3, pp. 512-519. https://doi.org/10.1016/j.eururo.2009.06.004
Roscigno, Marco ; Shariat, Shahrokh F. ; Margulis, Vitaly ; Karakiewicz, Pierre ; Remzi, Mesut ; Kikuchi, Eiji ; Zigeuner, Richard ; Weizer, Alon ; Sagalowsky, Arthur ; Bensalah, Karim ; Raman, Jay D. ; Bolenz, Christian ; Kassou, Wassim ; Koppie, Theresa M. ; Wood, Christopher G. ; Wheat, Jeffrey ; Langner, Cord ; Ng, Casey K. ; Capitanio, Umberto ; Bertini, Roberto ; Fernández, Mario I. ; Mikami, Shuji ; Isida, Masaru ; Ströbel, Philipp ; Montorsi, Francesco. / The Extent of Lymphadenectomy Seems to Be Associated with Better Survival in Patients with Nonmetastatic Upper-Tract Urothelial Carcinoma : How Many Lymph Nodes Should Be Removed?. In: European Urology. 2009 ; Vol. 56, No. 3. pp. 512-519.
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title = "The Extent of Lymphadenectomy Seems to Be Associated with Better Survival in Patients with Nonmetastatic Upper-Tract Urothelial Carcinoma: How Many Lymph Nodes Should Be Removed?",
abstract = "Background: The role and extent of lymphadenectomy in patients with upper-tract urothelial carcinoma (UTUC) is debated. Objective: To establish whether the number of lymph nodes (LNs) removed might be associated with better cause-specific survival in patients with UTUC. Design, setting, and participants: The study included 552 consecutive patients who underwent radical nephroureterectomy (RNU) and lymphadenectomy between 1992 and 2006. Intervention: Patients were treated with RNU and lymphadenectomy. Measurements: Univariable and multivariable Cox proportional hazards regression models addressed the association between the number of LNs removed and cause-specific mortality (CSM). The number of LNs removed was coded as a cubic spline to allow for nonlinear effects. Finally, the most informative cut-off for the number of removed LNs was identified. Results and limitations: In the entire population, the number of LNs removed was not associated with CSM in univariable (hazard ratio [HR]: 0.99; p = 0.16) or in multivariable (HR: 0.97; p = 0.12) analyses. In contrast, in the subgroup of pN0 patients (n = 412), the number of LNs removed achieved the independent predictor status of CSM (HR: 0.93; p = 0.02). Eight LNs removed was the most informative cut-off in predicting CSM (HR: 0.42; p = 0.004). The inclusion of the variable defining dichotomously the number of removed LNs (<8 vs ≥8) in the base model (age, Eastern Cooperative Oncology Group performance status, pathologic stage, grade, architecture, and lymphovascular invasion) significantly increased the accuracy in predicting CSM (+1.7{\%}; p < 0.001). Conclusions: The extension of the lymphadenectomy in pN0 UTUC patients seems to be associated with CSM. Longer survival was observed in patients in whom at least eight LNs had been removed.",
keywords = "Lymph node dissection, Metastasis, Nephroureterectomy, Prognosis, Survival, Urinary tract cancer, Urothelial carcinoma",
author = "Marco Roscigno and Shariat, {Shahrokh F.} and Vitaly Margulis and Pierre Karakiewicz and Mesut Remzi and Eiji Kikuchi and Richard Zigeuner and Alon Weizer and Arthur Sagalowsky and Karim Bensalah and Raman, {Jay D.} and Christian Bolenz and Wassim Kassou and Koppie, {Theresa M.} and Wood, {Christopher G.} and Jeffrey Wheat and Cord Langner and Ng, {Casey K.} and Umberto Capitanio and Roberto Bertini and Fern{\'a}ndez, {Mario I.} and Shuji Mikami and Masaru Isida and Philipp Str{\"o}bel and Francesco Montorsi",
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T1 - The Extent of Lymphadenectomy Seems to Be Associated with Better Survival in Patients with Nonmetastatic Upper-Tract Urothelial Carcinoma

T2 - How Many Lymph Nodes Should Be Removed?

AU - Roscigno, Marco

AU - Shariat, Shahrokh F.

AU - Margulis, Vitaly

AU - Karakiewicz, Pierre

AU - Remzi, Mesut

AU - Kikuchi, Eiji

AU - Zigeuner, Richard

AU - Weizer, Alon

AU - Sagalowsky, Arthur

AU - Bensalah, Karim

AU - Raman, Jay D.

AU - Bolenz, Christian

AU - Kassou, Wassim

AU - Koppie, Theresa M.

AU - Wood, Christopher G.

AU - Wheat, Jeffrey

AU - Langner, Cord

AU - Ng, Casey K.

AU - Capitanio, Umberto

AU - Bertini, Roberto

AU - Fernández, Mario I.

AU - Mikami, Shuji

AU - Isida, Masaru

AU - Ströbel, Philipp

AU - Montorsi, Francesco

PY - 2009/9

Y1 - 2009/9

N2 - Background: The role and extent of lymphadenectomy in patients with upper-tract urothelial carcinoma (UTUC) is debated. Objective: To establish whether the number of lymph nodes (LNs) removed might be associated with better cause-specific survival in patients with UTUC. Design, setting, and participants: The study included 552 consecutive patients who underwent radical nephroureterectomy (RNU) and lymphadenectomy between 1992 and 2006. Intervention: Patients were treated with RNU and lymphadenectomy. Measurements: Univariable and multivariable Cox proportional hazards regression models addressed the association between the number of LNs removed and cause-specific mortality (CSM). The number of LNs removed was coded as a cubic spline to allow for nonlinear effects. Finally, the most informative cut-off for the number of removed LNs was identified. Results and limitations: In the entire population, the number of LNs removed was not associated with CSM in univariable (hazard ratio [HR]: 0.99; p = 0.16) or in multivariable (HR: 0.97; p = 0.12) analyses. In contrast, in the subgroup of pN0 patients (n = 412), the number of LNs removed achieved the independent predictor status of CSM (HR: 0.93; p = 0.02). Eight LNs removed was the most informative cut-off in predicting CSM (HR: 0.42; p = 0.004). The inclusion of the variable defining dichotomously the number of removed LNs (<8 vs ≥8) in the base model (age, Eastern Cooperative Oncology Group performance status, pathologic stage, grade, architecture, and lymphovascular invasion) significantly increased the accuracy in predicting CSM (+1.7%; p < 0.001). Conclusions: The extension of the lymphadenectomy in pN0 UTUC patients seems to be associated with CSM. Longer survival was observed in patients in whom at least eight LNs had been removed.

AB - Background: The role and extent of lymphadenectomy in patients with upper-tract urothelial carcinoma (UTUC) is debated. Objective: To establish whether the number of lymph nodes (LNs) removed might be associated with better cause-specific survival in patients with UTUC. Design, setting, and participants: The study included 552 consecutive patients who underwent radical nephroureterectomy (RNU) and lymphadenectomy between 1992 and 2006. Intervention: Patients were treated with RNU and lymphadenectomy. Measurements: Univariable and multivariable Cox proportional hazards regression models addressed the association between the number of LNs removed and cause-specific mortality (CSM). The number of LNs removed was coded as a cubic spline to allow for nonlinear effects. Finally, the most informative cut-off for the number of removed LNs was identified. Results and limitations: In the entire population, the number of LNs removed was not associated with CSM in univariable (hazard ratio [HR]: 0.99; p = 0.16) or in multivariable (HR: 0.97; p = 0.12) analyses. In contrast, in the subgroup of pN0 patients (n = 412), the number of LNs removed achieved the independent predictor status of CSM (HR: 0.93; p = 0.02). Eight LNs removed was the most informative cut-off in predicting CSM (HR: 0.42; p = 0.004). The inclusion of the variable defining dichotomously the number of removed LNs (<8 vs ≥8) in the base model (age, Eastern Cooperative Oncology Group performance status, pathologic stage, grade, architecture, and lymphovascular invasion) significantly increased the accuracy in predicting CSM (+1.7%; p < 0.001). Conclusions: The extension of the lymphadenectomy in pN0 UTUC patients seems to be associated with CSM. Longer survival was observed in patients in whom at least eight LNs had been removed.

KW - Lymph node dissection

KW - Metastasis

KW - Nephroureterectomy

KW - Prognosis

KW - Survival

KW - Urinary tract cancer

KW - Urothelial carcinoma

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