Regional Lymph Node Dissection is associated with Improved Survival for Patients with Urothelial Cell Carcinoma
Abigail Kohut-Jackson1, Madison Schanz1, Julian Giakas1
1The Division of Urology, Department of Surgery, Saint Louis University, St. Louis, MO.
Purpose:
To evaluate practice patterns and overall survival outcomes for the performance of radical nephroureterectomy or ureterectomy stratified by utilization of lymph node dissection (LND) for patients with upper tract urothelial cell carcinoma.
Methods:
The National Cancer Database was queried for patients with upper tract urothelial cell carcinoma, cTanyN0M0 and cTanyN+M0, stratified by LND (pN0-1) versus no lymph node dissection (pNx) from 2006 to 2016. 17,455 patients met criteria for analysis; 9365 patients had primary renal tumors, and 8090 patients had primary ureteral tumors. We retrospectively analyzed trends in overall survival and 30- and 90-day mortality.
Results:
In the 9365 patients with primary renal or renal pelvis tumors, 48.8% underwent LND with 5.2% having pN+ disease. LND was associated with improved overall survival when compared with no LND (62.3% vs. 57.3%, P < .001). In the 8090 patients with primary ureteral tumors, 50.9% underwent LND and 3.6% had pN+ disease. Similarly, LND was associated with improved overall survival when compared with no LND (61.4% vs. 50.3%, P < .001). Multivariate analysis also demonstrated significant lower overall mortality in ureteral patients undergoing LND controlled for patient and clinical characteristics. Furthermore, in the ureteral group, patients with pN0 disease had improved 5-year-survival compared to pNx disease.
Conclusions:
LND in the setting of radical nephroureterectomy or ureterectomy has been historically underutilized, with less than half of patients with primary renal or primary ureteral tumors receiving LND from 2006 to 2016. Our analysis demonstrates a potential decreased mortality associated with LND for patients with upper tract urothelial cell carcinoma, notably in those with ureteral tumors, regardless of patient and clinical characteristics.
