Abstract
BackgroundWe aimed to estimate the stage-specific impact of lymph node dissection (LND) on survival for upper urinary tract urothelial carcinoma (UTUC) patients treated with nephroureterectomy (NU).MethodsOverall, 7278 UTUC patients undergoing NU within the SEER database from 2004 to 2015 were identified. Kaplan-Meier plots illustrated overall survival (OS) and cancer-specific survival (CSS) rates according to LND status. Multivariable Cox regression analyses assessed the effect of LND on OS and CSS rates stratified by pathological tumor stage.ResultsLND was performed in 26.9% of patients, and in 18.6, 23.3, 31.2 and 45.9% for pT1, pT2, pT3 and pT4 patients, respectively (P < 0.001). In multivariable Cox regression analyses, LND was associated with a higher OS or CSS in UTUC patients with pT3 and pT4 disease (all P < 0.05), but failed to achieve independent predictor status in patients with pT1 and pT2 disease (all P > 0.05). LND with 1 to 3 regional lymph nodes removed was prone to a higher OS or CSS only in pT4 compared to no LND (both P < 0.01). LND with 4 or more regional lymph nodes removed predisposed to a higher OS or CSS in pT3 or pT4 (all P < 0.05).ConclusionsThe beneficial effect of LND especially LND with 4 or more regional lymph nodes removed on survival was evident in pT3/4 patients. LND can be considered for pT3 and pT4, for pT1/2 remains to be seen, both of which will be verified by further prospective studies.
Highlights
We aimed to estimate the stage-specific impact of lymph node dissection (LND) on survival for upper urinary tract urothelial carcinoma (UTUC) patients treated with nephroureterectomy (NU)
LND was performed in only 26.9% of the UTUC patients, which seemed to be infrequent compared to the LND rate 75.0% at radical cystectomy (RC) for nonmetastatic bladder transitional cell carcinoma [8]
LND was more frequently performed in locally advanced UTUC patients
Summary
We aimed to estimate the stage-specific impact of lymph node dissection (LND) on survival for upper urinary tract urothelial carcinoma (UTUC) patients treated with nephroureterectomy (NU). LND was omitted in a large amount of UTUC patients. A recent research observed that LND was performed in only 36% of UTUC. Zhai et al BMC Cancer (2019) 19:1207 patients who underwent NU and LND was performed more frequently in patients treated with open NU [7]. Few previous studies have evaluated the effect of LND on survival for UTUC patients with different tumor stage separately. To resolve this issue, we tested the impact of LND at NU on overall survival (OS) and cancer-specific survival (CSS). Our hypothesis stated that LND may benefit OS and CSS, which is consistent across all tumor stages
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