Lymphadenectomy For Urothelial Carcinoma Research Articles

Impact of variant differentiation on patient survival after radical cystectomy in urothelial carcinoma of the bladder

Objective To find out the impact of variant histologic differentiation of patients with urothelial carcinoma of the bladder on survival after radical cystectomy. Methods Between 2006 and 2012, 418 consecutive patients who underwent radical cystectomy with lymphadenectomy for urothelial carcinoma of the bladder were included. The patients were divided into three groups: group A included 262 patients with pure urothrothial carcinoma, group B included 103 patients with squamous and/or glandular differentiation and group 3 comprised 53 patients with non–squamous and/or glandular differentiation. Cancer–specific and overall survivals were compared using Kaplan–Meier method, Log–rank test and multivariable Cox proportional hazard regression analyses. Results Of the 418 patients, 108 were diagnosed with a single variant histology, and 58 had multiple patterns. Squamous differentiation (n=48; 11.5%) was the most common single variant histology, followed by glandular (n=40; 9.6%) and sarcomatoid(n=13; 3.1%). Compared to group A, group B and C were more likely to have advanced tumor stage(pT4 in group B vs group C vs group A: 29, 14, 24; 28.2% vs 26.4% vs 9.2%), lymph node metastases(35, 13, 31; 34.0% vs 24.5% vs 11.8%)and lymphovascular invasion(45, 22, 49; 43.7% vs 41.5% vs18.7%)(P–values<0.017). In univariable analyses, group B and group C were at significantly higher risk for cancer specific mortality and overall mortality than patients with pure UCB (P–values<0.01). In multivariable analyses, group C had significantly prognostic influence in cancer–specific mortality (HR 2.49, 95%CI 1.32–4.67, P<0.01) and overall mortality (HR 2.21, 95%CI 1.31–3.73, P<0.01). Conclusion Variant differentiation was independently associated with adverse outcomes for patients with urothelial carcinoma of the bladder after radical cystectomy. Key words: Urothelial carcinoma; Pathology; Prognosis; Radical cystectomy; Variant

Therapeutic role of template-based lymphadenectomy in urothelial carcinoma of the upper urinary tract.

Lymphadenectomy for urothelial carcinoma of the upper urinary tract has attracted the attention of physicians. The mapping study of lymphatic spread has shown that a relatively wide area should comprise the regional nodes for tumors of the right renal pelvis or the right upper two-thirds of the ureter. A prospective study showed that an anatomical template-based lymphadenectomy significantly improved patient survival in tumors of the renal pelvis. This benefit was more evident for patients with pT2 stage tumors or higher. The risk of regional node recurrence is significant reduced by template-based lymphadenectomy, which is likely to be associated with improved patient survival. The removal of lymph node micrometastases is assumed to be the reason for therapeutic benefit following lymphadenectomy. The number of resected lymph nodes can be used to assess the quality of lymphadenectomy, but not to determine the extent of lymphadenectomy. The guidelines currently recommend lymphadenectomy for patients with muscle-invasive disease, even though the current recommendation grades are still low. The present limitation of lymphadenectomy is the lack of standardization of the extent of lymphadenectomy and the randomized trials. Further studies are warranted to collect the evidence to support lymphadenectomy.

Template-based lymphadenectomy in urothelial carcinoma of the renal pelvis: a prospective study.

Recent studies showed the therapeutic benefit of lymphadenectomy in advanced stage urothelial carcinoma of the upper urinary tract, but there is still a lack of prospective studies and standardization of the extent of lymphadenectomy. The aim of this multi-institutional study was to examine the role of lymphadenectomy in urothelial carcinoma of the upper urinary tract. From January 2005 to September 2012, 77 patients undergoing nephroureterectomy and lymphadenectomy for non-metastatic (cN0M0) urothelial carcinoma of the upper urinary tract were included in a prospective study at two Japanese institutions(lymphadenectomy group). Lymphadenectomies were carried out according to definite anatomical template. Results from this group were compared with those from a control group of 89 patients who did not receive lymphadenectomy during the study period (no lymphadenectomy group). In patients with urothelial carcinoma of the upper urinary tract in the renal pelvis of pathological stage 2 or higher, template-based lymphadenectomy resulted in significantly higher cancer-specific survival (89.8% and 51.7%, P = 0.01) and overall survival (86.1% and 48.0%, P = 0.01). Disease-free survival tended to be higher in the lymphadenectomy group(77.8% and 50.0%, P = 0.06). Template-based lymphadenectomy was a significant independent factor for reducing the risk of cancer death in patients with renal pelvic cancer of ≥ pT2 by multivariate analysis. In contrast, cancer-specific survival of patients with ureteral urothelial carcinoma of the upper urinary tract was not significantly different between the lymphadenectomy and no lymphadenectomy groups. This multi-institutional prospective study further supports the therapeutic role of template-based lymphadenectomy in patients with advanced-stage urothelial carcinoma of the upper urinary tract in the renal pelvis. This is not the case for patients with ureteral urothelial carcinoma of the upper urinary tract.

Editorial Comment to Template-based lymphadenectomy in urothelial carcinoma of the renal pelvis: A prospective study

Editorial Comment to Template-based lymphadenectomy in urothelial carcinoma of the renal pelvis: A prospective study

Template‐based lymphadenectomy in urothelial carcinoma of the renal pelvis: A prospective study

ObjectivesRecent studies showed the therapeutic benefit of lymphadenectomy in advanced stage urothelial carcinoma of the upper urinary tract, but there is still a lack of prospective studies and standardization of the extent of lymphadenectomy. The aim of this multi‐institutional study was to examine the role of lymphadenectomy in urothelial carcinoma of the upper urinary tract.MethodsFrom January 2005 to September 2012, 77 patients undergoing nephroureterectomy and lymphadenectomy for non‐metastatic (cN0M0) urothelial carcinoma of the upper urinary tract were included in a prospective study at two Japanese institutions (lymphadenectomy group). Lymphadenectomies were carried out according to definite anatomical template. Results from this group were compared with those from a control group of 89 patients who did not receive lymphadenectomy during the study period (no lymphadenectomy group).ResultsIn patients with urothelial carcinoma of the upper urinary tract in the renal pelvis of pathological stage 2 or higher, template‐based lymphadenectomy resulted in significantly higher cancer‐specific survival (89.8% and 51.7%, P = 0.01) and overall survival (86.1% and 48.0%, P = 0.01). Disease‐free survival tended to be higher in the lymphadenectomy group (77.8% and 50.0%, P = 0.06). Template‐based lymphadenectomy was a significant independent factor for reducing the risk of cancer death in patients with renal pelvic cancer of ≥pT2 by multivariate analysis. In contrast, cancer‐specific survival of patients with ureteral urothelial carcinoma of the upper urinary tract was not significantly different between the lymphadenectomy and no lymphadenectomy groups.ConclusionsThis multi‐institutional prospective study further supports the therapeutic role of template‐based lymphadenectomy in patients with advanced‐stage urothelial carcinoma of the upper urinary tract in the renal pelvis. This is not the case for patients with ureteral urothelial carcinoma of the upper urinary tract.

821 Therapeutic benefit from template-based lymphadenectomy in urothelial carcinoma of the renal pelvis – multi-institutional prospective study

821 Therapeutic benefit from template-based lymphadenectomy in urothelial carcinoma of the renal pelvis – multi-institutional prospective study

Role of lymphadenectomy in the management of urothelial carcinoma of the bladder and the upper urinary tract

The role of lymphadenectomy has been controversial in urological malignancies. Urothelial carcinoma of the bladder and upper urinary tract has a high potential to spread through the lymphatic network compared with other malignancies, including renal cell carcinoma or prostate cancer. In urothelial carcinoma of the bladder, lymphadenectomy of pelvic nodes had been considered as the standard procedure when radical cystectomy was carried out. Recently, many investigators have examined the influence of its extent, and the majority of the studies have supported the beneficial role of extended lymphadenectomy in accurate staging or in improving patient survival. Although randomized controlled trials are required to establish a greater level of evidence, more urological surgeons have already noticed the necessity for extended lymphadenectomy in bladder cancer. In contrast to bladder cancer, there have been far fewer studies on urothelial carcinoma of the upper urinary tract. This might be because of the smaller number of the patients with urothelial carcinoma of the upper urinary tract and the lack of understanding of regional nodes. However, studies of lymph node mapping and the retrospective analyses with respect to the benefit of lymphadenectomy have been carried out in urothelial carcinoma of the upper urinary tract by some investigators, although the results are still controversial. However, the results from multi-institutional studies by high volume centers have supported the beneficial role of lymphadenectomy in urothelial carcinoma of the upper urinary tract, as it has been proposed in bladder cancer. Thus, lymphadenectomy for urothelial carcinoma of the bladder and the upper urinary tract might have a potential role in staging and improving the oncological outcomes.

Template‐based lymphadenectomy in urothelial carcinoma of the upper urinary tract: Impact on patient survival

The benefit of lymphadenectomy (LND) in patients with urothelial carcinoma of the upper urinary tract (UCUUT) has remained controversial. The aim of this study was to examine the influence of the LND template and the total number of lymph nodes (LN) when increasing the number of patients undergoing complete dissection of regional nodes (CompLND). A total of 109 UCUUT patients with clinically negative nodes underwent nephroureterectomy with concomitant lymphadenectomy at our center. Patients' survival was examined according to the type of LND and the number of removed LN. Univariate analysis was performed to find the cut-off value of LN influencing survival. Seventy-eight patients underwent CompLND. Incomplete lymphadenectomy was performed in an additional 41 patients. In the patients with pT2 or higher who were clinically negative for nodal metastasis, any cut-off value for the total number of LN removed showed no statistical significance. In contrast, CompLND had a significant impact on patient survival. The Cox proportional hazard model showed that CompLND was a significant factor after adjusting for adjuvant chemotherapy. The total number of removed LN was not significant. In patients with muscle-invasive clinical node-negative UCUUT, the number of LN removed shows minimal influence on their survival. In contrast, the influence of the particular type of lymphadenectomy is statistically significant. These findings suggest that the extent of lymphadenectomy should be determined by the template and not by the number of removed LN.