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