Frontiers in Oncology (Apr 2022)
Is Lymph Node Dissection Necessary During Radical Nephroureterectomy for Clinically Node-Negative Upper Tract Urothelial Carcinoma? A Multi-Institutional Study
- 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
Affiliations
- Hsiang-Ying Lee
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Hsiang-Ying Lee
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Hsiang-Ying Lee
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
- Hsiang-Ying Lee
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Chao-Hsiang Chang
- Department of Urology, China Medical University and Hospital, Taichung, Taiwan
- Chao-Hsiang Chang
- School of Medicine, China Medical University, Taichung, Taiwan
- Chi-Ping Huang
- Department of Urology, China Medical University and Hospital, Taichung, Taiwan
- Chi-Ping Huang
- School of Medicine, China Medical University, Taichung, Taiwan
- Chih-Chin Yu
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City, Taiwan
- Chih-Chin Yu
- School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
- Chi-Wen Lo
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City, Taiwan
- Shiu-Dong Chung
- Graduate Program in Biomedical Informatics, College of Informatics, Yuan-Ze University, Chung-Li, Taiwan
- Shiu-Dong Chung
- 0Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Wei-Che Wu
- 0Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Wei-Che Wu
- 1Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
- I-Hsuan Alan Chen
- 2Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Jen-Tai Lin
- 2Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Yuan-Hong Jiang
- 3Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
- Yu-Khun Lee
- 3Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
- Thomas Y. Hsueh
- 4Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch, Taipei, Taiwan
- Thomas Y. Hsueh
- 5Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Allen W. Chiu
- 6College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Yung-Tai Chen
- 7Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
- Chang-Min Lin
- 7Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
- Yao-Chou Tsai
- 8Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Yao-Chou Tsai
- 9Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan
- Wei-Chieh Chen
- 9Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan
- Bing-Juin Chiang
- 0College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
- Bing-Juin Chiang
- 1Department of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan
- Bing-Juin Chiang
- 2Department of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan
- Hsu-Che Huang
- 1Department of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan
- Hsu-Che Huang
- 2Department of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan
- Chung-Hsin Chen
- 3Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Chao-Yuan Huang
- 3Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Chia-Chang Wu
- 8Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Chia-Chang Wu
- 4Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Chia-Chang Wu
- 5TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
- Wei Yu Lin
- 6Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Wei Yu Lin
- 7Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Wei Yu Lin
- 8Department of Medicine, Chang Gung University, Taoyuan, Taiwan
- Jen-Shu Tseng
- 9Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan
- Jen-Shu Tseng
- 0Department of Urology, Mackay Medical College, New Taipei City, Taiwan
- Jen-Shu Tseng
- 1Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Hung-Lung Ke
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Hung-Lung Ke
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Hung-Lung Ke
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
- Hung-Lung Ke
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Hsin-Chih Yeh
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Hsin-Chih Yeh
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Hsin-Chih Yeh
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
- Hsin-Chih Yeh
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- DOI
- https://doi.org/10.3389/fonc.2022.791620
- Journal volume & issue
-
Vol. 12
Abstract
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.
Keywords
- lymph node dissection
- clinical lymph node negative
- muscle-invasive stage
- pathological lymph node positive
- upper tract urothelial carcinoma
