ASCO GU 2018: Utility Of Lymph Node Dissection for Clinical Node Negative Upper Tract Urothelial Cell Carcinoma: A Multicenter Study

San Francisco, CA ( Upper tract urothelial cell carcinoma (UTUC) is an uncommon aggressive malignancy with disparate outcomes. Although use of lymph node dissection (LND) for urothelial cell carcinoma of the bladder has demonstrated a 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. The authors evaluated survival outcomes for UTUC after LND.


This was a 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+). The primary outcome was overall survival (OS). The secondary outcome was recurrence free survival (RFS). 


A total of 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). In a Cox regression model 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 Kaplan Meier curves, a 5 year OS stratified by pathologic node status and nuclear grade (grade 1-2 = low grade; grade 3-4 = high grade) noted negative survival effect associated with pN+ and high grade disease (pN0 low grade 85.7%, pN0 high grade 41.2%, pNx low grade 58.1%, pNx HG 51.1%, pN+ high grade 10.7%, log-rank p < 0.001). No patient with pN+ had low grade disease. On logistic regression multivariable analysis, high grade 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).


The authors concluded that in clinical node negative disease, LND for UTUC did not have a survival benefit; however, LND for UTUC provided prognostic information without significantly increasing the risk of complications. Finding of pN+ disease was associated with worsened prognosis. LND may be omitted in low grade disease, yet should be considered in patients with high grade disease and increasing tumor size.

Presented by: Zachary Hamilton, Saint Louis University, St Louis, MO

Co Authors:  Miki Haifler, Laura-Maria Krabbe, Timothy N Clinton, Daniel Han, Stephen Ryan, Madhumitha Reddy, Charles Field, Aaron Bloch, Fang Wan, Robert Uzzo, Vitaly Margulis, Ithaar Derweesh; Saint Louis University, St Louis, MO; Fox Chase Cancer Center, Philadelphia, PA; UT Southwestern Medical Center, Dallas, TX; University of California San Diego, San Diego, CA

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the 2018 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, February 8-10, 2018 - San Francisco, CA