The Value of Lymph Node Dissection in Patients with Upper Tract Urothelial Cancer - Expert Commentary

The value of Lymph Node Dissection during radical nephroureterectomy for patients with upper tract urothelial carcinoma is unclear. Xia et al. analyzed the impact of lymph node dissection on survival outcomes in patients with upper tract urothelial cancer.

Using the Surveillance, Epidemiology, and End Results (SEER) database to collect lymph node data from patients with upper tract urothelial cancer who had pathologically confirmed stages, the investigators identified 306 node-positive upper tract urothelial cancer patients. In a multivariable Cox regression analysis, age, a tumor size larger than 2 cm, T4 stage, lack of adjuvant chemotherapy, and higher positive lymph node density were associated with poor overall survival. The median number of removed lymph nodes, positive lymph nodes, and positive lymph node density were 8, 3, and 33.3%, respectively. Tumor size larger than 2 cm, T3 or T4 stages, lack of adjuvant chemotherapy, and higher positive lymph node density were independent predictors of lower cancer-specific survival. This risk increased with positive lymph node density in a non-linear manner. The most informative cutoff value for positive lymph node density was 27%. Using this cutoff, the five-year cancer-specific survival rates were 75.9%, and 52.9% overall survival rates were 34.2% and 18.7% in patients with positive lymph node density ≥27% compared to those with positive lymph node density <25%. A multivariable Cox proportional hazards model with positive lymph node density could accurately predict survival over five years.

Xia et al. provide evidence on the value of lymphadenectomy for patients with node-positive urinary tract urothelial cancer. Higher positive lymph node density was associated with poorer survival and showed predictive efficacy. It may therefore be used as a predictive marker, in addition to a marker for risk stratification. Importantly, due to the retrospective and observational study design, some variables that could affect survival outcomes were missing from patient data, such as the schedule and type of adjuvant chemotherapy and surgical method for removal.

Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine, New York City, New York

References:

  1. Xia HR, Li SG, Zhai XQ, Liu M, Guo XX, Wang JY. The Value of Lymph Node Dissection in Patients With Node-Positive Upper Urinary Tract Urothelial Cancer: A Retrospective Cohort Study. Front Oncol. 2022;12:889144. Published 2022 Jun 16. doi:10.3389/fonc.2022.889144
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