The Association between Lymph Node Dissection and Survival in Lymph Node-Negative Upper Urinary Tract Urothelial Cancer
The benefit of lymph node dissection (LND) during radical nephroureterectomy (RNU) in lymph node (LN)-negative (cN0/pN0) UTUC remains controversial. We aimed to assess the association between LND and its extent and survival in LN-negative UTUC. The Surveillance, Epidemiology, and End Results databas...
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MDPI AG
2023-09-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/15/18/4660 |
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| author | Aleksander Ślusarczyk Piotr Zapała Tomasz Piecha Paweł Rajwa Marco Moschini Piotr Radziszewski |
| author_facet | Aleksander Ślusarczyk Piotr Zapała Tomasz Piecha Paweł Rajwa Marco Moschini Piotr Radziszewski |
| author_sort | Aleksander Ślusarczyk |
| collection | DOAJ |
| description | The benefit of lymph node dissection (LND) during radical nephroureterectomy (RNU) in lymph node (LN)-negative (cN0/pN0) UTUC remains controversial. We aimed to assess the association between LND and its extent and survival in LN-negative UTUC. The Surveillance, Epidemiology, and End Results database was searched to identify patients with non-metastatic chemotherapy-naïve cN0/pNx or pN0 UTUC who underwent RNU +/− LND between 2004 and 2019. Overall, 4649 patients with cN0/pNx or pN0 UTUC were analyzed, including 909 (19.55%) individuals who had LND. Among them, only in 368 patients (7.92%) was LND extended to at least four LNs, and the remaining 541 patients (11.64%) have had < four LNs removed. In the whole cohort, LND contributed to better cancer-specific survival (CSS) and overall survival (OS). Furthermore, a propensity score-matched analysis adjusted for confounders confirmed that improved CSS and OS was achieved only when ≥ four LNs had been removed, especially in muscle-invasive UTUC. A multivariable analysis further confirmed an association between the extent of LND and CSS. To conclude, adequate LND during RNU was associated with improved OS and CSS in LN-negative UTUC, particularly in muscle-invasive stage. This underscores that a sufficient LN yield is required to reveal a therapeutic benefit in patients undergoing RNU. |
| first_indexed | 2024-03-10T22:57:43Z |
| format | Article |
| id | doaj.art-da65ee41784a4c30aa060cc63910316b |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T22:57:43Z |
| publishDate | 2023-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-da65ee41784a4c30aa060cc63910316b2023-11-19T09:56:54ZengMDPI AGCancers2072-66942023-09-011518466010.3390/cancers15184660The Association between Lymph Node Dissection and Survival in Lymph Node-Negative Upper Urinary Tract Urothelial CancerAleksander Ślusarczyk0Piotr Zapała1Tomasz Piecha2Paweł Rajwa3Marco Moschini4Piotr Radziszewski5Department of General, Oncological and Functional Urology, Medical University of Warsaw, 02-005 Warsaw, PolandDepartment of General, Oncological and Functional Urology, Medical University of Warsaw, 02-005 Warsaw, PolandDepartment of General, Oncological and Functional Urology, Medical University of Warsaw, 02-005 Warsaw, PolandDepartment of Urology, Medical University of Silesia, 41-800 Zabrze, PolandDepartment of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, 20132 Milan, ItalyDepartment of General, Oncological and Functional Urology, Medical University of Warsaw, 02-005 Warsaw, PolandThe benefit of lymph node dissection (LND) during radical nephroureterectomy (RNU) in lymph node (LN)-negative (cN0/pN0) UTUC remains controversial. We aimed to assess the association between LND and its extent and survival in LN-negative UTUC. The Surveillance, Epidemiology, and End Results database was searched to identify patients with non-metastatic chemotherapy-naïve cN0/pNx or pN0 UTUC who underwent RNU +/− LND between 2004 and 2019. Overall, 4649 patients with cN0/pNx or pN0 UTUC were analyzed, including 909 (19.55%) individuals who had LND. Among them, only in 368 patients (7.92%) was LND extended to at least four LNs, and the remaining 541 patients (11.64%) have had < four LNs removed. In the whole cohort, LND contributed to better cancer-specific survival (CSS) and overall survival (OS). Furthermore, a propensity score-matched analysis adjusted for confounders confirmed that improved CSS and OS was achieved only when ≥ four LNs had been removed, especially in muscle-invasive UTUC. A multivariable analysis further confirmed an association between the extent of LND and CSS. To conclude, adequate LND during RNU was associated with improved OS and CSS in LN-negative UTUC, particularly in muscle-invasive stage. This underscores that a sufficient LN yield is required to reveal a therapeutic benefit in patients undergoing RNU.https://www.mdpi.com/2072-6694/15/18/4660lymph node dissectionupper urinary tract urothelial cancerradical nephroureterectomylymph nodessurvivalSEER |
| spellingShingle | Aleksander Ślusarczyk Piotr Zapała Tomasz Piecha Paweł Rajwa Marco Moschini Piotr Radziszewski The Association between Lymph Node Dissection and Survival in Lymph Node-Negative Upper Urinary Tract Urothelial Cancer Cancers lymph node dissection upper urinary tract urothelial cancer radical nephroureterectomy lymph nodes survival SEER |
| title | The Association between Lymph Node Dissection and Survival in Lymph Node-Negative Upper Urinary Tract Urothelial Cancer |
| title_full | The Association between Lymph Node Dissection and Survival in Lymph Node-Negative Upper Urinary Tract Urothelial Cancer |
| title_fullStr | The Association between Lymph Node Dissection and Survival in Lymph Node-Negative Upper Urinary Tract Urothelial Cancer |
| title_full_unstemmed | The Association between Lymph Node Dissection and Survival in Lymph Node-Negative Upper Urinary Tract Urothelial Cancer |
| title_short | The Association between Lymph Node Dissection and Survival in Lymph Node-Negative Upper Urinary Tract Urothelial Cancer |
| title_sort | association between lymph node dissection and survival in lymph node negative upper urinary tract urothelial cancer |
| topic | lymph node dissection upper urinary tract urothelial cancer radical nephroureterectomy lymph nodes survival SEER |
| url | https://www.mdpi.com/2072-6694/15/18/4660 |
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