SUO 2017: Utility Of Lymph Node Dissection For Clinical Node Negative Upper Tract Urothelial Cell Carcinoma: A Multicenter Study

Washington, DC ( Introduction: 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, this cannot be said with certainty about LND in the setting of clinical node negative disease for UTUC. The authors therefore evaluated survival outcomes for UTUC after LND.

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