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The impact of lymph node status and features on oncological outcomes in urothelial carcinoma of the upper urinary tract (UTUC) treated by nephroureterectomy

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Abstract

Purpose

Prognostic impact of lymphadenectomy during radical nephroureterectomy (RNU) for urothelial carcinoma of the upper urinary tract (UTUC) is controversial. Our aim was to assess the impact of lymph node status (LNS) on survival in patients treated by RNU.

Methods

In our multi-institutional, retrospective database, 714 patients with non-metastatic UTUC had undergone RNU between 1995 and 2010. LNS was tested as prognostic factor for survivals through univariate and multivariable Cox regression analysis.

Results

Median age was 70 years [interquartile range (IQR), 60–75] with median follow-up of 27 months (IQR, 10–50). Overall, lymphadenectomy was performed in 254 patients (35.5 %). Among these patients, 204 (80 %) had negative lymph nodes (pN0) and 50 (20 %) had positive lymph nodes (pN1/2). The 5-year cancer-specific survival (CSS) was 81 % [95 % confidence interval (CI), 73–88 %] for pN0 patients, 85 % (95 % CI, 80–90 %) for pNx patients and 47 % (95 % CI, 24–69 %) for pN1/2 patients (p < 0.001). Metastasis-free survival (MFS) and overall survival (OS) rates were significantly lower in pN1/2 patients than in pN0 and pNx patients (p < 0.05). On multivariable analysis, LNS did not appear as an independent prognostic factor for CSS, OS or MFS (p > 0.05). In case of lymph node involvement, extra-nodal extension was marginally associated with worse CSS (log rank p = 0.07). The retrospective design was the main limitation.

Conclusion

LNS is helpful for survival stratification in patients treated with RNU for UTUC. However, LNS did not appear as an independent predictor of survival in this retrospective series and needs to be investigated in a large multicentre, prospective evaluation.

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Acknowledgments

The authors would like to kindly thank other collaborators from the French collaborative national database on UTUC: Baptiste Albouy, Mehdi Mokhtar Ariane, Frederic Arroua, Marie Audouin, Alexis Arvin Berod, Pierre Bigot, Nicolas Brichart, Franck Bruyere, Thomas Bodin, Jean-Nicolas Cornu, Sébastien Crouzet, Francky Delage, Aurélien Descazeaud, Stéphane Droupy, Pierre Olivier Fais, Solène Gardic, Pascal Gres, Julien Guillotreau, Laurent Guy, Sophie Hurel, Jacques Irani, Jean-Alexandre Long, Charles Marchand, Alexandre Matte, Olivier Merigot de Treigny, Yann Neuzillet, Géraldine Pignot, Emmanuel Ravier, François Rozet, Marc Soulié, Antoine Valeri and Evanguelos Xylinas.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Academic Department of Urology, CHU Lille, Univ Lille Nord de France, 59000, Lille, France

    Adil Ouzzane, Pierre Colin & Tarek P. Ghoneim

  2. Academic Department of Urology, Cochin Hospital, 75014, Paris, France

    Marc Zerbib

  3. Academic Department of Urology, CHU Henri Mondor, 94010, Créteil, France

    Alexandre De La Taille

  4. Academic Department of Urology of la Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France

    François Audenet & Morgan Rouprêt

  5. Academic Department of Urology, CHRU Amiens, University of Amiens, Amiens, France

    Fabien Saint

  6. Academic Department of Urology, CHRU Angers, University of Angers, Angers, France

    Nicolas Hoarau

  7. Academic Department of Urology, Edouard Herriot Hospital, Claude Bernard Lyon 1 University, Lyon, France

    Emilie Adam

  8. Academic Department of Urology, CHRU Reims, University of Reims, Reims, France

    Marie Dominique Azemar

  9. Academic Department of Urology, CHRU Caen, University of Caen, Caen, France

    Henri Bensadoun

  10. Academic Department of Urology, CHRU Dijon, University of Dijon, Dijon, France

    Luc Cormier

  11. Academic Department of Urology of Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France

    Olivier Cussenot

  12. Department of Urology, Val de Grâce Military Hospital, Paris, France

    Alain Houlgatte

  13. Academic Department of Urology, CHU Marseille, University of Marseille, Marseille, France

    Gilles Karsenty

  14. Academic Department of Urology of La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, University of Marseille, Marseille, France

    Charlotte Maurin

  15. Academic Department of Urology, CHRU Rouen, University of Rouen, Rouen, France

    François Xavier Nouhaud

  16. Department of Urology, Foch Hospital, University of Paris-Ile de France Ouest, Suresnes, France

    Véronique Phe

  17. Academic Department of Urology, CHRU Clermont Ferrand, University of Clermont Ferrand, Clermont Ferrand, France

    Thomas Polguer

  18. Academic Department of Urology, CHRU Toulouse, University of Toulouse, Toulouse, France

    Mathieu Roumiguié

  19. Academic Department of Urology, Lyon Sud Hospital, Claude Bernard Lyon 1 University, Lyon, France

    Alain Ruffion

  20. Department of Urology, CHRU Lille, 2 rue Michel Polonovski, 59037, Lille Cedex, France

    Adil Ouzzane

Authors
  1. Adil Ouzzane
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  2. Pierre Colin
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  3. Tarek P. Ghoneim
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  4. Marc Zerbib
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  5. Alexandre De La Taille
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  6. François Audenet
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  7. Fabien Saint
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  8. Nicolas Hoarau
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  9. Emilie Adam
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  10. Marie Dominique Azemar
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  11. Henri Bensadoun
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  12. Luc Cormier
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  13. Olivier Cussenot
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  14. Alain Houlgatte
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  15. Gilles Karsenty
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  16. Charlotte Maurin
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  17. François Xavier Nouhaud
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  18. Véronique Phe
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  19. Thomas Polguer
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  20. Mathieu Roumiguié
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  21. Alain Ruffion
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  22. Morgan Rouprêt
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Corresponding author

Correspondence to Pierre Colin.

Additional information

This study is conducted for the French collaborative national database on UTUC.

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Ouzzane, A., Colin, P., Ghoneim, T.P. et al. The impact of lymph node status and features on oncological outcomes in urothelial carcinoma of the upper urinary tract (UTUC) treated by nephroureterectomy. World J Urol 31, 189–197 (2013). https://doi.org/10.1007/s00345-012-0983-1

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  • DOI: https://doi.org/10.1007/s00345-012-0983-1

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