MP78-10 HIGHER RISK OF RECURRENCE AT EXTRAREGIONAL NODES AFTER RADICAL NEPHROURETERECTOMY IN PATIENTS WITH LEFT THAN IN PATIENTS WITH RIGHT URETERAL CANCER

Abstract

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma II1 Apr 2017MP78-10 HIGHER RISK OF RECURRENCE AT EXTRAREGIONAL NODES AFTER RADICAL NEPHROURETERECTOMY IN PATIENTS WITH LEFT THAN IN PATIENTS WITH RIGHT URETERAL CANCER Tsunenori Kondo, Isao Hara, Toshio Takagi, Yoshiki Kodama, Kenji Omae, Junpei Iizuka, Kazuhiko Yoshida, Hironori Fukuda, and Kazunari Tanabe Tsunenori KondoTsunenori Kondo More articles by this author , Isao HaraIsao Hara More articles by this author , Toshio TakagiToshio Takagi More articles by this author , Yoshiki KodamaYoshiki Kodama More articles by this author , Kenji OmaeKenji Omae More articles by this author , Junpei IizukaJunpei Iizuka More articles by this author , Kazuhiko YoshidaKazuhiko Yoshida More articles by this author , Hironori FukudaHironori Fukuda More articles by this author , and Kazunari TanabeKazunari Tanabe More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2098AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We reported the lack of therapeutic effect of lymphadenectomy on lower ureteral cancer (LUC). We further examined this mechanism by analyzing the recurrence pattern and factors influencing the outcome of LUC. METHODS From January 1988 to September 2016, we performed radical nephroureterectomy for 83 patients with non-metastatic (clinically N0 M0) LUC at two Japanese institutes. The lower ureter was designated as located below the crossing of the common iliac artery. Metastatic sites were identified with radiological imaging studies or resected specimens. Regional nodes of LUC were identified as ipsilateral pelvic nodes below the aortic bifurcation, according to the description in our previous study. RESULTS The mean age of the 83 patients was 71.2 years (range: 38–90 years), and the mean follow-up period was 48 months (range: 2–225 months). Radical nephroureterectomy was performed for 41 patients with right LUC and for 42 patients with left LUC. No significant difference was found in the patients who underwent template-based lymphadenectomy (34% in the right and 36% in the left LUC, p=0.88). The 5-year recurrence-free and cancer-specific survival rates were respectively 71.9% and 80.1% in the right LUC, and 50.6% and 62.7% in the left LUC. The difference was statistically significant (p=0.02 and 0.03, respectively; Figure 1). The incidence of lymph node recurrence was even higher in the patients with left LUC (24%) than in those with right LUC (2%), and 60% of the lymph node recurrences occurred at the extraregional nodes in the left LUC. The multivariate analysis revealed that the factors that influenced cancer-specific survival were left ureteral tumors (hazard ratio [HR], 3.38; p=0.02) and pathological stage T3 or higher (HR, 28.9; p=0.002). Template-based lymphadenectomy or adjuvant chemotherapy was not a significant factor. CONCLUSIONS This multi-institutional study shows a higher risk of extraregional nodes recurrence after nephroureterectomy in patients with left LUC, which is likely to be associated with worse oncological outcome of left LUC than right LUC. Template-based lymphadenectomy alone appears inadequate to improve patient survival in left LUC. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1034-e1035 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Tsunenori Kondo More articles by this author Isao Hara More articles by this author Toshio Takagi More articles by this author Yoshiki Kodama More articles by this author Kenji Omae More articles by this author Junpei Iizuka More articles by this author Kazuhiko Yoshida More articles by this author Hironori Fukuda More articles by this author Kazunari Tanabe More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...