J Korean Med Sci.  2009 Aug;24(4):674-678. 10.3346/jkms.2009.24.4.674.

Clinical Significance of Lymph Node Dissection in Patients with Muscle-Invasive Upper Urinary Tract Transitional Cell Carcinoma Treated with Nephroureterectomy

• Cho KS
• Choi HM
• Koo K
• Park SJ
• Rha KH
• Choi YD
• Chung BH
• Cho NH
• Yang SC
• Hong SJ

• KMID: 1779202
• DOI: http://doi.org/10.3346/jkms.2009.24.4.674

Abstract

We investigated the value of lymph node dissection in patients with cN0 muscle-invasive transitional cell carcinoma of the upper urinary tract (UUT-TCC). Medical records of 152 patients with cN0 muscle-invasive UUT-TCC, who underwent nephroureterectomy between 1986 and 2005, were reviewed. Sixty-three patients (41.4%) underwent lymph node dissection. The median number of lymph nodes harvested was 6 (range, 1 to 35), and from these, lymph node involvement was confirmed in 9 patients (14.3%). Locoregional recurrence (LR) and disease-recurrence (DR) occurred in 29 patients and 63 patients, respectively. Fifty-five patients (36.2%) had died of cancer at the last follow-up. The number of lymph nodes harvested was associated with the reduction of LR (chi-square(trend)=6.755, P=0.009), but was not associated with DR (chi-square(trend)=1.558, P=0.212). In the survival analysis, N stage (P=0.0251) and lymph node dissection (P=0.0073) had significant influence on LR, but not on DR or disease-specific survival. However, the number of lymph nodes harvested did not affect LR-free, DR-free, or disease-specific survival. We conclude that lymph node dissection may improve the control of locoregional cancer, as well as staging accuracy, in cN0 muscle-invasive UUT-TCC, but that it does not clearly influence survival.

Keyword

Carcinoma, Transitional Cell; Ureter; Kidney Pelvis; Recurrence; Lymph Node Excision

MeSH Terms

Aged
Aged, 80 and over
Carcinoma, Transitional Cell/mortality/*surgery/therapy
Female
Humans
Kidney Neoplasms/mortality/*surgery/therapy
*Lymph Node Excision
Male
Middle Aged
Neoplasm Staging
Nephrectomy
Recurrence
Retrospective Studies
Survival Analysis
Ureteral Neoplasms/mortality/*surgery/therapy

Figure

• 

  Fig. 1 Locoregional recurrence-free survival curves according to number of lymph nodes harvested (A) and N stage (B). NLN, number of lymph nodes harvested.

Reference

1. Cozad SC, Smalley SR, Austenfeld M, Noble M, Jennings S, Raymond R. Transitional cell carcinoma of the renal pelvis or ureter: patterns of failure. Urology. 1995. 46:796–800.

2. Hall MC, Womack S, Sagalowsky AI, Carmody T, Erickstad MD, Roehrborn CG. Prognostic factors, recurrence, and survival in transitional cell carcinoma of the upper urinary tract: a 30-year experience in 252 patients. Urology. 1998. 52:594–601.

3. Batata MA, Whitmore WF, Hilaris BS, Tokita N, Grabstald H. Primary carcinoma of the ureter: a prognostic study. Cancer. 1975. 35:1626–1632.

4. Grabstald H, Whitmore WF, Melamed MR. Renal pelvic tumors. JAMA. 1971. 218:845–854.

5. Ozsahin M, Zouhair A, Villa S, Storme G, Chauvet B, Taussky D, Gouders D, Ries G, Bontemps P, Coucke PA, Mirimanoff RO. Prognostic factors in urothelial renal pelvis and ureter tumours: a multicentre Rare Cancer Network study. Eur J Cancer. 1999. 35:738–743.

6. Herr HW, Donat SM. Outcome of patients with grossly node positive bladder cancer after pelvic lymph node dissection and radical cystectomy. J Urol. 2001. 165:62–64.

7. Leissner J, Ghoneim MA, Abol-Enein H, Thuroff JW, Franzaring L, Fisch M, Schulze H, Managadze G, Allhoff EP, el-Baz MA, Kastendieck H, Buhtz P, Kropf S, Hohenfellner R, Wolf HK. Extended radical lymphadenectomy in patients with urothelial bladder cancer: results of a prospective multicenter study. J Urol. 2004. 171:139–144.

8. Stein JP. Lymphadenectomy in bladder cancer: how high is "high enough"? Urol Oncol. 2006. 24:349–355.

9. Brausi MA, Gavioli M, De Luca G, Verrini G, Peracchia G, Simonini G, Viola M. Retroperitoneal lymph node dissection (RPLD) in conjunction with nephroureterectomy in the treatment of infiltrative transitional cell carcinoma (TCC) of the upper urinary tract: impact on survival. Eur Urol. 2007. 52:1414–1418.

10. Komatsu H, Tanabe N, Kubodera S, Maezawa H, Ueno A. The role of lymphadenectomy in the treatment of transitional cell carcinoma of the upper urinary tract. J Urol. 1997. 157:1622–1624.

11. Kondo T, Nakazawa H, Ito F, Hashimoto Y, Toma H, Tanabe K. Impact of the extent of regional lymphadenectomy on the survival of patients with urothelial carcinoma of the upper urinary tract. J Urol. 2007. 178:1212–1217.

12. Miyake H, Hara I, Gohji K, Arakawa S, Kamidono S. The significance of lymphadenectomy in transitional cell carcinoma of the upper urinary tract. Br J Urol. 1998. 82:494–498.

13. Secin FP, Koppie TM, Salamanca JI, Bokhari S, Raj GV, Olgac S, Serio A, Vickers A, Bochner BH. Evaluation of regional lymph node dissection in patients with upper urinary tract urothelial cancer. Int J Urol. 2007. 14:26–32.

14. Epstein JI, Amin MB, Reuter VR, Mostofi FK. The World Health Organization/International Society of Urological Pathology consensus classification of urothelial (transitional cell) neoplasms of the urinary bladder. Bladder Consensus Conference Committee. Am J Surg Pathol. 1998. 22:1435–1448.

15. Greene FL, Page DL, Fleming ID, Fritz AG, Balch CM, Haller DG, Morrow M. AJCC Cancer Staging Manual. 2002. 6th ed. New York: Springer Verlag.

16. Park S, Hong B, Kim CS, Ahn H. The impact of tumor location on prognosis of transitional cell carcinoma of the upper urinary tract. J Urol. 2004. 171:621–625.

17. Kondo T, Nakazawa H, Ito F, Hashimoto Y, Toma H, Tanabe K. Primary site and incidence of lymph node metastases in urothelial carcinoma of upper urinary tract. Urology. 2007. 69:265–269.

18. Schatteman P, Chatzopoulos C, Assenmacher C, De Visscher L, Jorion JL, Blaze V, Van Cleynenbreugel B, Billiet I, Van der Eecken H, Bollens R, Mottrie A. Laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma: results of a Belgian retrospective multicentre survey. Eur Urol. 2007. 51:1633–1638.

19. Tsujihata M, Nonomura N, Tsujimura A, Yoshimura K, Miyagawa Y, Okuyama A. Laparoscopic nephroureterectomy for upper tract transitional cell carcinoma: comparison of laparoscopic and open surgery. Eur Urol. 2006. 49:332–336.

20. McNeill SA, Chrisofos M, Tolley DA. The long-term outcome after laparoscopic nephroureterectomy: a comparison with open nephroureterectomy. BJU Int. 2000. 86:619–623.