PD07-10 UTILITY OF LYMPH NODE DISSECTION FOR CLINICAL NODE NEGATIVE UPPER TRACT UROTHELIAL CELL CARCINOMA: A MULTICENTER STUDY (2018)

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy I1 Apr 2018PD07-10 UTILITY OF LYMPH NODE DISSECTION FOR CLINICAL NODE NEGATIVE UPPER TRACT UROTHELIAL CELL CARCINOMA: A MULTICENTER STUDY Zachary Hamilton, Miki Haifler, Laura-Maria Krabbe, Timothy Clinton, Daniel Han, Stephen Ryan, Madhumitha Reddy, Charles Field, Aaron Bloch, Robert Uzzo, Vitaly Margulis, and Ithaar Derweesh Zachary HamiltonZachary Hamilton More articles by this author , Miki HaiflerMiki Haifler More articles by this author , Laura-Maria KrabbeLaura-Maria Krabbe More articles by this author , Timothy ClintonTimothy Clinton More articles by this author , Daniel HanDaniel Han More articles by this author , Stephen RyanStephen Ryan More articles by this author , Madhumitha ReddyMadhumitha Reddy More articles by this author , Charles FieldCharles Field More articles by this author , Aaron BlochAaron Bloch More articles by this author , Robert UzzoRobert Uzzo More articles by this author , Vitaly MargulisVitaly Margulis More articles by this author , and Ithaar DerweeshIthaar Derweesh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.443AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Upper tract urothelial cell carcinoma (UTUC) is an uncommon malignancy with disparate outcomes. Although use of lymph node dissection (LND) for urothelial cell carcinoma of the bladder has survival benefit even in setting of negative nodal status, therapeutic benefit of LND in the setting of clinical node negative disease for UTUC is unclear. We evaluated survival outcomes for UTUC after LND. METHODS Multicenter retrospective analysis of UTUC patients undergoing nephroureterectomy (NU) for clinical node negative, non-metastatic disease from 2001-2016 (cTis/1-T3N0M0). The cohort was divided based on pathologic lymph node status (pNx, pN0, and pN+). Primary outcome was overall survival (OS). Secondary outcome was recurrence free survival (RFS). Cox regression (CR), logistic regression (LR) and Kaplan-Meier (KMA) analyses were utilized. RESULTS 191 patients were analyzed (mean age 71.1 years, mean follow up 30.4 months, 27% ureteral location). LND was performed in 40.8% (78) and pN+ was noted in 11.0% (21). Mean number of nodes removed for pN0=6.6 and pN+=3.9 (p=0.22). On CR for worsened all-cause mortality, significance was noted for ≥pT2 (OR 1.9, p=0.031), recurrence (OR 2.3, p=0.003), and pN+ (OR 2.8, p=0.004). On KMA, 5 year OS stratified by pathologic node status and nuclear grade (grade 1-2=LG; grade 3-4=HG) noted negative survival effect associated with pN+ and HG disease (pN0 LG 85.7%, pN0 HG 41.2%, pNx LG 58.1%, pNx HG 51.1%, pN+ HG 10.7%, log-rank p<0.001). No patient with pN+ had LG disease. On LR, HG disease was predicted only by increasing clinical tumor size (OR 1.3, p=0.032). No significant difference in complications was noted between the groups (p=0.1). CONCLUSIONS In clinical node negative disease, LND for UTUC did not have survival benefit; however, LND for UTUC provided prognostic information without significantly increasing risk of complications. Finding of pN+ disease was associated with worsened prognosis. LND may not be necessary in LG disease yet should be considered in patients with HG disease and increasing tumor size. Further investigation is requisite. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e160 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Zachary Hamilton More articles by this author Miki Haifler More articles by this author Laura-Maria Krabbe More articles by this author Timothy Clinton More articles by this author Daniel Han More articles by this author Stephen Ryan More articles by this author Madhumitha Reddy More articles by this author Charles Field More articles by this author Aaron Bloch More articles by this author Robert Uzzo More articles by this author Vitaly Margulis More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...