Editorial Comment

Abstract

Patients with invasive upper tract transitional cell carcinoma (UTTCC) pose a difficult management problem with prognosis dependent on the degree of invasion, the relationship, if any, to previous superficial or invasive bladder cancer, and the presence of metastatic nodes. Similar to invasive bladder cancer, preoperative staging can often be inaccurate and distinguishing superficial invasion from deep invasion may not always be possible. Unlike invasive bladder cancer, strategies to improve survival rates using neoadjuvant systemic chemotherapy before nephroureterectomy have not been subjected to clinical trials. However, many urological and medical oncologists advocate systemic platinum-based chemotherapy before nephroureterectomy with the expectations of improving survival rates of 40%-70% for T2-T3 tumors. 1 Hall C.M. Womack S. Sagalowsky A.I. et al. Prognostic factors, recurrence, and survival in transitional cell carcinoma of the upper urinary tract: a 30 year experience in 252 patients. Cancer. 1998; 52: 594-601 Google Scholar , 2 Balaji K.C. McGuire M. Grotas J. et al. Upper tract recurrences following radical cystectomy: an analysis of prognostic factors, recurrence pattern, and stage of presentation. J Urol. 1999; 162: 1603-1606 Abstract Full Text Full Text PDF Scopus (87) Google Scholar , 3 Mullerad M. Russo P. Golijanin D. et al. Bladder cancer as a prognostic factor for upper tract transitional cell carcinoma. J Urol. 2004; 172: 2177-2181 Abstract Full Text Full Text PDF Scopus (83) Google Scholar , 4 Novara G. De Marco V. Gottardp F. et al. Independent predictors of cancer specific survival in transitional cell carcinoma of the upper urinary tract. Cancer. 2007; 110: 1715-1722 Crossref Scopus (165) Google Scholar The need for a complete, meticulous, full, bilateral pelvic lymphadenectomy has been established for invasive bladder cancer with a therapeutic advantage achieved for micrometastatic disease as well as critical information for decision-making regarding adjuvant systemic therapies. 5 Herr H.W. Bochner B.H. Dalbagni G. et al. Impact of the number of lymph nodes retrieved on outcome in patients with muscle invasive bladder cancer. J Urol. 2002; 167: 1295-1298 Abstract Full Text Full Text PDF Scopus (508) Google Scholar Still, for reasons not clear, the concept of meticulous retroperitoneal node dissection for invasive UTTCC has not been adopted by urologists worldwide despite reports for a similar therapeutic and staging advantage as reported in invasive bladder cancer. 6 Brausi M.A. Gavioli M. De Luca G. et al. Retroperitoneal lymph node dissection in conjunction with nephroureterectomy in the treatment of infiltrative transitional cell carcinoma of the upper urinary tract: impact on survival. Eur Urol. 2007; 52: 1414-1420 Abstract Full Text Full Text PDF Scopus (106) Google Scholar , 7 Roscigno M. Cozzarini C. Bertini R. et al. Prognostic value of lymph node dissection in patients with muscle-invasive transitional cell carcinoma of the upper urinary tract. Eur Urol. 2008; 53: 794-802 Abstract Full Text Full Text PDF Scopus (135) Google Scholar Assessment of the Minimum Number of Lymph Nodes Needed to Detect Lymph Node Invasion at Radical Nephroureterectomy in Patients With Upper Tract Urothelial CancerUrologyVol. 74Issue 5PreviewTo determine whether a minimum number of lymph nodes (LNs) exist to detect lymph node invasion (LNI) in patients undergoing radical nephroureterectomy (RNU) for upper tract urothelial carcinoma. Full-Text PDF Editorial CommentUrologyVol. 74Issue 5PreviewThis is a well-conducted retrospective review of a large cohort of patients with upper tract urothelial carcinoma. I commend the authors on their efforts in establishing the minimum extent of nodal dissection in this patient population. To date, there is increasing evidence on both the prognostic and therapeutic effects of lymphadenectomy in patients with urothelial carcinoma of the bladder undergoing cystectomy. Furthermore, numerous studies have examined the limits and extent of lymph node dissection in patients with bladder cancer. Full-Text PDF ReplyUrologyVol. 74Issue 5PreviewDespite the prognostic and predictive effect of lymph node (LN) metastases, the benefit of lymphadenectomy (LND) in patients treated with radical nephroureterectomy (RNU) for urinary tract urothelial cancer (UTUC) remains debatable, and the procedure is still not widely performed.1,2 Even in our retrospective study, the low median number of nodes removed reflects a significant problem of quality of care when performing LND in patients with upper tract disease. Full-Text PDF ReplyUrologyVol. 74Issue 5PreviewA maximum of 30% of patients with muscle-invasive UTUC show nodal metastases at the time of surgery, which represents a well established poor prognostic factor.1 Despite the prognostic and predictive effect of LN metastases, the benefit of lymphadenectomy (LND) in patients treated with radical nephroureterectomy (RNU) for UTUC remains debatable, and the procedure is not widely performed.2,3 Full-Text PDF