Is Lymph Node Dissection Necessary During Radical Nephroureterectomy for Clinically Node-Negative Upper Tract Urothelial Carcinoma? A Multi-Institutional Study
PurposeThis study aimed to compare the oncological outcomes of patients with upper tract urothelial carcinoma (UTUC) without clinical lymph node metastasis (cN0) undergoing lymph node dissection (LND) during radical nephroureterectomy (NU).MethodsFrom the updated data of the Taiwan UTUC Collaboratio...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-04-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2022.791620/full |
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| author | Hsiang-Ying Lee Hsiang-Ying Lee Hsiang-Ying Lee Hsiang-Ying Lee Chao-Hsiang Chang Chao-Hsiang Chang Chi-Ping Huang Chi-Ping Huang Chih-Chin Yu Chih-Chin Yu Chi-Wen Lo Shiu-Dong Chung Shiu-Dong Chung Wei-Che Wu Wei-Che Wu I-Hsuan Alan Chen Jen-Tai Lin Yuan-Hong Jiang Yu-Khun Lee Thomas Y. Hsueh Thomas Y. Hsueh Allen W. Chiu Yung-Tai Chen Chang-Min Lin Yao-Chou Tsai Yao-Chou Tsai Wei-Chieh Chen Bing-Juin Chiang Bing-Juin Chiang Bing-Juin Chiang Hsu-Che Huang Hsu-Che Huang Chung-Hsin Chen Chao-Yuan Huang Chia-Chang Wu Chia-Chang Wu Chia-Chang Wu Wei Yu Lin Wei Yu Lin Wei Yu Lin Jen-Shu Tseng Jen-Shu Tseng Jen-Shu Tseng Hung-Lung Ke Hung-Lung Ke Hung-Lung Ke Hung-Lung Ke Hsin-Chih Yeh Hsin-Chih Yeh Hsin-Chih Yeh Hsin-Chih Yeh |
| author_facet | Hsiang-Ying Lee Hsiang-Ying Lee Hsiang-Ying Lee Hsiang-Ying Lee Chao-Hsiang Chang Chao-Hsiang Chang Chi-Ping Huang Chi-Ping Huang Chih-Chin Yu Chih-Chin Yu Chi-Wen Lo Shiu-Dong Chung Shiu-Dong Chung Wei-Che Wu Wei-Che Wu I-Hsuan Alan Chen Jen-Tai Lin Yuan-Hong Jiang Yu-Khun Lee Thomas Y. Hsueh Thomas Y. Hsueh Allen W. Chiu Yung-Tai Chen Chang-Min Lin Yao-Chou Tsai Yao-Chou Tsai Wei-Chieh Chen Bing-Juin Chiang Bing-Juin Chiang Bing-Juin Chiang Hsu-Che Huang Hsu-Che Huang Chung-Hsin Chen Chao-Yuan Huang Chia-Chang Wu Chia-Chang Wu Chia-Chang Wu Wei Yu Lin Wei Yu Lin Wei Yu Lin Jen-Shu Tseng Jen-Shu Tseng Jen-Shu Tseng Hung-Lung Ke Hung-Lung Ke Hung-Lung Ke Hung-Lung Ke Hsin-Chih Yeh Hsin-Chih Yeh Hsin-Chih Yeh Hsin-Chih Yeh |
| author_sort | Hsiang-Ying Lee |
| collection | DOAJ |
| description | PurposeThis study aimed to compare the oncological outcomes of patients with upper tract urothelial carcinoma (UTUC) without clinical lymph node metastasis (cN0) undergoing lymph node dissection (LND) during radical nephroureterectomy (NU).MethodsFrom the updated data of the Taiwan UTUC Collaboration Group, a total of 2726 UTUC patients were identified. We only include patients with ≥ pT2 stage and enrolled 658 patients. The Kaplan–Meier estimator and Cox proportional hazards model were used to analyze overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and bladder recurrence-free survival (BRFS) in LND (+) and LND (−) groups.ResultsA total of 658 patients were included and 463 patients without receiving LND and 195 patients receiving LND. From both univariate and multivariate survival analysis, there are no significant difference between LND (+) and LND (-) group in survival rate. In LND (+) group, 18.5% patients have pathological LN metastasis. After analyzing pN+ subgroup, it revealed worse CSS (p = 0.010) and DFS (p < 0.001) compared with pN0 patients.ConclusionsWe found no significant survival benefit related to LND in cN0 stage, ≥ pT2 stage UTUC, irrespective of the number of LNs removed, although pN+ affected cancer prognosis. However, from the result of pN (+) subgroup of LND (+) cohort analysis, it may be reasonable to not perform LND in patients with cT2N0 stage due to low positive predictive value of pN (+). In addition, performing LND may be considered for ureter cancer, which tends to cause lymphatic and hematogenous tumor spreading. Further large prospective studies are needed to validate our findings. |
| first_indexed | 2024-04-14T06:57:56Z |
| format | Article |
| id | doaj.art-5f6b4ec32c204c91bd2dbf94420118af |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-04-14T06:57:56Z |
| publishDate | 2022-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-5f6b4ec32c204c91bd2dbf94420118af2022-12-22T02:06:49ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2022-04-011210.3389/fonc.2022.791620791620Is Lymph Node Dissection Necessary During Radical Nephroureterectomy for Clinically Node-Negative Upper Tract Urothelial Carcinoma? A Multi-Institutional StudyHsiang-Ying Lee0Hsiang-Ying Lee1Hsiang-Ying Lee2Hsiang-Ying Lee3Chao-Hsiang Chang4Chao-Hsiang Chang5Chi-Ping Huang6Chi-Ping Huang7Chih-Chin Yu8Chih-Chin Yu9Chi-Wen Lo10Shiu-Dong Chung11Shiu-Dong Chung12Wei-Che Wu13Wei-Che Wu14I-Hsuan Alan Chen15Jen-Tai Lin16Yuan-Hong Jiang17Yu-Khun Lee18Thomas Y. Hsueh19Thomas Y. Hsueh20Allen W. Chiu21Yung-Tai Chen22Chang-Min Lin23Yao-Chou Tsai24Yao-Chou Tsai25Wei-Chieh Chen26Bing-Juin Chiang27Bing-Juin Chiang28Bing-Juin Chiang29Hsu-Che Huang30Hsu-Che Huang31Chung-Hsin Chen32Chao-Yuan Huang33Chia-Chang Wu34Chia-Chang Wu35Chia-Chang Wu36Wei Yu Lin37Wei Yu Lin38Wei Yu Lin39Jen-Shu Tseng40Jen-Shu Tseng41Jen-Shu Tseng42Hung-Lung Ke43Hung-Lung Ke44Hung-Lung Ke45Hung-Lung Ke46Hsin-Chih Yeh47Hsin-Chih Yeh48Hsin-Chih Yeh49Hsin-Chih Yeh50Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, TaiwanDepartment of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, TaiwanDepartment of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, TaiwanGraduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, TaiwanDepartment of Urology, China Medical University and Hospital, Taichung, TaiwanSchool of Medicine, China Medical University, Taichung, TaiwanDepartment of Urology, China Medical University and Hospital, Taichung, TaiwanSchool of Medicine, China Medical University, Taichung, TaiwanDivision of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City, TaiwanSchool of Medicine, Buddhist Tzu Chi University, Hualien, TaiwanDivision of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City, TaiwanGraduate Program in Biomedical Informatics, College of Informatics, Yuan-Ze University, Chung-Li, Taiwan0Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan0Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan1Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan2Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan2Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan3Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan3Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan4Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch, Taipei, Taiwan5Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan6College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan7Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan7Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan8Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan9Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan9Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan0College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan1Department of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan2Department of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan1Department of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan2Department of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan3Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan3Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan8Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan4Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan5TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan6Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan7Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan8Department of Medicine, Chang Gung University, Taoyuan, Taiwan9Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan0Department of Urology, Mackay Medical College, New Taipei City, Taiwan1Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, TaiwanDepartment of Urology, Kaohsiung Medical University Hospital, Kaohsiung, TaiwanDepartment of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, TaiwanDepartment of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, TaiwanGraduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, TaiwanDepartment of Urology, Kaohsiung Medical University Hospital, Kaohsiung, TaiwanDepartment of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, TaiwanDepartment of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, TaiwanGraduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, TaiwanPurposeThis study aimed to compare the oncological outcomes of patients with upper tract urothelial carcinoma (UTUC) without clinical lymph node metastasis (cN0) undergoing lymph node dissection (LND) during radical nephroureterectomy (NU).MethodsFrom the updated data of the Taiwan UTUC Collaboration Group, a total of 2726 UTUC patients were identified. We only include patients with ≥ pT2 stage and enrolled 658 patients. The Kaplan–Meier estimator and Cox proportional hazards model were used to analyze overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and bladder recurrence-free survival (BRFS) in LND (+) and LND (−) groups.ResultsA total of 658 patients were included and 463 patients without receiving LND and 195 patients receiving LND. From both univariate and multivariate survival analysis, there are no significant difference between LND (+) and LND (-) group in survival rate. In LND (+) group, 18.5% patients have pathological LN metastasis. After analyzing pN+ subgroup, it revealed worse CSS (p = 0.010) and DFS (p < 0.001) compared with pN0 patients.ConclusionsWe found no significant survival benefit related to LND in cN0 stage, ≥ pT2 stage UTUC, irrespective of the number of LNs removed, although pN+ affected cancer prognosis. However, from the result of pN (+) subgroup of LND (+) cohort analysis, it may be reasonable to not perform LND in patients with cT2N0 stage due to low positive predictive value of pN (+). In addition, performing LND may be considered for ureter cancer, which tends to cause lymphatic and hematogenous tumor spreading. Further large prospective studies are needed to validate our findings.https://www.frontiersin.org/articles/10.3389/fonc.2022.791620/fulllymph node dissectionclinical lymph node negativemuscle-invasive stagepathological lymph node positiveupper tract urothelial carcinoma |
| spellingShingle | Hsiang-Ying Lee Hsiang-Ying Lee Hsiang-Ying Lee Hsiang-Ying Lee Chao-Hsiang Chang Chao-Hsiang Chang Chi-Ping Huang Chi-Ping Huang Chih-Chin Yu Chih-Chin Yu Chi-Wen Lo Shiu-Dong Chung Shiu-Dong Chung Wei-Che Wu Wei-Che Wu I-Hsuan Alan Chen Jen-Tai Lin Yuan-Hong Jiang Yu-Khun Lee Thomas Y. Hsueh Thomas Y. Hsueh Allen W. Chiu Yung-Tai Chen Chang-Min Lin Yao-Chou Tsai Yao-Chou Tsai Wei-Chieh Chen Bing-Juin Chiang Bing-Juin Chiang Bing-Juin Chiang Hsu-Che Huang Hsu-Che Huang Chung-Hsin Chen Chao-Yuan Huang Chia-Chang Wu Chia-Chang Wu Chia-Chang Wu Wei Yu Lin Wei Yu Lin Wei Yu Lin Jen-Shu Tseng Jen-Shu Tseng Jen-Shu Tseng Hung-Lung Ke Hung-Lung Ke Hung-Lung Ke Hung-Lung Ke Hsin-Chih Yeh Hsin-Chih Yeh Hsin-Chih Yeh Hsin-Chih Yeh Is Lymph Node Dissection Necessary During Radical Nephroureterectomy for Clinically Node-Negative Upper Tract Urothelial Carcinoma? A Multi-Institutional Study Frontiers in Oncology lymph node dissection clinical lymph node negative muscle-invasive stage pathological lymph node positive upper tract urothelial carcinoma |
| title | Is Lymph Node Dissection Necessary During Radical Nephroureterectomy for Clinically Node-Negative Upper Tract Urothelial Carcinoma? A Multi-Institutional Study |
| title_full | Is Lymph Node Dissection Necessary During Radical Nephroureterectomy for Clinically Node-Negative Upper Tract Urothelial Carcinoma? A Multi-Institutional Study |
| title_fullStr | Is Lymph Node Dissection Necessary During Radical Nephroureterectomy for Clinically Node-Negative Upper Tract Urothelial Carcinoma? A Multi-Institutional Study |
| title_full_unstemmed | Is Lymph Node Dissection Necessary During Radical Nephroureterectomy for Clinically Node-Negative Upper Tract Urothelial Carcinoma? A Multi-Institutional Study |
| title_short | Is Lymph Node Dissection Necessary During Radical Nephroureterectomy for Clinically Node-Negative Upper Tract Urothelial Carcinoma? A Multi-Institutional Study |
| title_sort | is lymph node dissection necessary during radical nephroureterectomy for clinically node negative upper tract urothelial carcinoma a multi institutional study |
| topic | lymph node dissection clinical lymph node negative muscle-invasive stage pathological lymph node positive upper tract urothelial carcinoma |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2022.791620/full |
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