Methods: 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+). Primary outcome was overall survival (OS), and secondary outcome was recurrence free survival (RFS).
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 Cox regression 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). 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. 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).
Conclusion: 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 be omitted in LG disease. However it should be considered in patients with clinical HG disease and increasing tumor size.
Presented by: Zachary Hamilton, San Diego, USA
Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, @GoldbergHanan, at the 18th Annual Meeting of the Society of Urologic Oncology, November 29-December 1, 2017 – Washington, DC