PD43-08 OUTCOMES OF LYMPH NODE DISSECTION IN NEPHROURETERECTOMY IN THE TREATMENT OF UPPER TRACT UROTHELIAL CARCINOMA: ANALYSIS OF THE ROBUUST REGISTRY (2021)

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma I (PD43)1 Sep 2021PD43-08 OUTCOMES OF LYMPH NODE DISSECTION IN NEPHROURETERECTOMY IN THE TREATMENT OF UPPER TRACT UROTHELIAL CARCINOMA: ANALYSIS OF THE ROBUUST REGISTRY Kevin Hakimi, Riccardo Autorino, Umberto Carbonara, Reza Mehrazin, Andrew Katims, Dan Eun, Adam Reese, Mark Ganzalgo, Amit Bhattu, Roger Li, Robert Uzzo, Vitaly Margulis, Jim Porter, Chandru Sundaram, Jason Farrow, Hooman Djaladat, Antoin Douglawi, Firas Abdollah, Marcus Jamil, Alexandre Mottrie, Andrea Minervini, Matteo Ferro, Margaret Meagher, Shady Soliman, Julia Yuan, Koon Rha, Zhenjie Wu, Giuseppe Simone, and Ithaar Derweesh Kevin HakimiKevin Hakimi More articles by this author , Riccardo AutorinoRiccardo Autorino More articles by this author , Umberto CarbonaraUmberto Carbonara More articles by this author , Reza MehrazinReza Mehrazin More articles by this author , Andrew KatimsAndrew Katims More articles by this author , Dan EunDan Eun More articles by this author , Adam ReeseAdam Reese More articles by this author , Mark GanzalgoMark Ganzalgo More articles by this author , Amit BhattuAmit Bhattu More articles by this author , Roger LiRoger Li More articles by this author , Robert UzzoRobert Uzzo More articles by this author , Vitaly MargulisVitaly Margulis More articles by this author , Jim PorterJim Porter More articles by this author , Chandru SundaramChandru Sundaram More articles by this author , Jason FarrowJason Farrow More articles by this author , Hooman DjaladatHooman Djaladat More articles by this author , Antoin DouglawiAntoin Douglawi More articles by this author , Firas AbdollahFiras Abdollah More articles by this author , Marcus JamilMarcus Jamil More articles by this author , Alexandre MottrieAlexandre Mottrie More articles by this author , Andrea MinerviniAndrea Minervini More articles by this author , Matteo FerroMatteo Ferro More articles by this author , Margaret MeagherMargaret Meagher More articles by this author , Shady SolimanShady Soliman More articles by this author , Julia YuanJulia Yuan More articles by this author , Koon RhaKoon Rha More articles by this author , Zhenjie WuZhenjie Wu More articles by this author , Giuseppe SimoneGiuseppe Simone More articles by this author , and Ithaar DerweeshIthaar Derweesh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002057.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Utility of lymph node dissection (LND) in localized upper tract urothelial carcinoma (UTUC) is controversial. We evaluated outcomes of LND in patients with UTUC using a multi-institutional dataset. METHODS: We performed a retrospective analysis utilizing the ROBUUST registry (RObotic surgery for Upper Tract Urothelial Cancer Study) of UTUC patients undergoing nephroureterectomy from 2006-2019. The cohort was divided into patients who did not undergo LND (pNx), patients who underwent LND with negative lymph nodes (pN0), and patients who underwent LND with positive nodes (pN+). Primary outcome was overall survival (OS). Secondary outcomes were cancer-specific survival (CSS) and progression-free survival (PFS). Multivariable analyses (MVA) were conducted for risk factors associated with outcomes. Kaplan-Meier analyses (KMA) were utilized to compare survival outcomes between pNx, pN0, and pN+ groups. RESULTS: 877 patients were analyzed (median follow up 19.6 months). LND was performed in 358 (40.8%), with pN+ in 73 (8.3%). Compared to pN0/pNx patients, pN+ patients had larger median clinical tumor size (pN+ 4.1 vs. pN0 3.6 vs. pNx 3.3 cm, p=0.012) and larger proportion of high grade (cis, III, IV) tumors (pN+ 98.6% vs. pN0 82.8% vs. pNx 80.2%, p=0.001). Median number of nodes obtained was 10.2 for pN+ and 9.8 for pN0. MVA noted increasing age (OR 1.1, p<0.001), pN+ (OR 3.1, p<0.001), adjuvant chemotherapy (OR 1.5, p=0.012), and pathologic stage pTis/3/4 (OR 3.4, p<0.001) to be predictive for all-cause mortality. MVA found pN+ (OR 2.2, p<0.001), adjuvant chemotherapy (OR 0.6, p<0.025), and pathologic stage pTis/3/4 (OR 2.2, p=0.022) to be predicative for cancer-specific mortality. MVA noted increasing age (OR 1.01 , p=0.031), pN+ (OR 1.7, p=0.007), and adjuvant chemotherapy (OR 1.4, p<0.001) to be predictive for recurrence. KMA for pNx, pN0 and pN+ groups demonstrated: 5-year OS of 77%, 77%, and 44% (p<0.001); 5-year CSS of 89%, 89%, and 47% (p<0.001); and 5-year PFS of 45%, 59%, and 26% (p<0.001). CONCLUSIONS: In the present multi-national cohort of patients undergoing minimally invasive nephroureterectomy, performance of LND provides staging data, with pN+ patients having worsened outcomes, and pN0 patients having similar outcomes to pNx patients. Source of Funding: Stephen Weissman Kidney Cancer Research Fund © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e733-e734 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Hakimi More articles by this author Riccardo Autorino More articles by this author Umberto Carbonara More articles by this author Reza Mehrazin More articles by this author Andrew Katims More articles by this author Dan Eun More articles by this author Adam Reese More articles by this author Mark Ganzalgo More articles by this author Amit Bhattu More articles by this author Roger Li More articles by this author Robert Uzzo More articles by this author Vitaly Margulis More articles by this author Jim Porter More articles by this author Chandru Sundaram More articles by this author Jason Farrow More articles by this author Hooman Djaladat More articles by this author Antoin Douglawi More articles by this author Firas Abdollah More articles by this author Marcus Jamil More articles by this author Alexandre Mottrie More articles by this author Andrea Minervini More articles by this author Matteo Ferro More articles by this author Margaret Meagher More articles by this author Shady Soliman More articles by this author Julia Yuan More articles by this author Koon Rha More articles by this author Zhenjie Wu More articles by this author Giuseppe Simone More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement PDF downloadLoading ...