EAU 2018: Utility of Lymph Node Dissection for Clinical Node Negative Upper Tract Urothelial Cell Carcinoma: A Multicenter Study

Copenhagen, Denmark (UroToday.com)  Dr. Derweesh from UC San Diego discussed results of a multi-center study evaluating clinical node negative UTUC lymphadenectomy. Although the use of a lymph node dissection 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. The objective of this study was to evaluate survival outcomes for UTUC after lymphadenectomy.

For this study, the authors used a multicenter, retrospective analysis of UTUC patients undergoing nephroureterectomy for clinical node negative, non-metastatic disease from 2001-2016 (cTis/1-T3N0M0). The cohort was stratified based on pathologic lymph node status (pNx vs pN0 vs pN+). The primary outcome was overall survival (OS). Cox proportional hazards modeling, logistic regression, and Kaplan−Meier analyses were utilized.

There were 191 patients analyzed, with a mean age of 71.1 years, mean follow up 30.4 months, and 27% with ureteral tumor location. A lymphadenectomy was performed in 40.8% and pN+ was noted in 11.0%. The mean number of nodes removed for pN0 was 6.6 and for pN+ patients was 3.9 (p=0.22). With regards to all-cause mortality, significance was noted for ≥pT2 (HR 1.9, p=0.031), recurrence (HR 2.3, p=0.003), and pN+ (HR 2.8, p=0.004). The 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 high-grade 51.1%, pN+ high-grade 10.7%, log-rank p<0.001). No patient with pN+ had low-grade disease. 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 for clinical node negative disease, lymphadenectomy for UTUC did not have survival benefit, however lymphadenectomy for UTUC provided prognostic information without significantly increasing risk of complications. A finding of pN+ disease was associated with worse prognosis. A lymphadenectomy may be omitted in low-grade disease yet should be considered in patients with high-grade disease and increasing tumor size. 

Presented by: Ithaar H. Derweesh, University of California-San Diego, San Diego, CA

Co-Authors: Hamilton Z. 1 , Haifler M. 2 , Krabbe L. 3 , Clinton T. 3 , Han D. 1 , Ryan S. 1 , Reddy
M. 1 , Field C. 1 , Bloch A. 1 , Uzzo R. 2 , Margulis V. 3 , Derweesh I. 1

Author Information:
1. University of California, Dept. of Urology, San Diego, United States of America
2. Fox Chase Cancer Center, Dept. of Urology, Philadelphia, United States of America
3. University of Texas Southwest, Dept. of Urology, Dallas, United States of America

Written by: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, twitter: @zklaassen_md at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark