Clinical Oncology: Outcomes & Complications

Moderated Poster Session

MP23-1 - Utility of Lymph Node Dissection for Clinical Node Negative Upper Tract Urothelial Cell Carcinoma: A Multicenter Study

Saturday, September 22
2:00 PM - 4:00 PM
Location: Room 253

Introduction & Objective :

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, therapeutic benefit of LND in the setting of clinical node negative disease for UTUC is unclear. We evaluated survival outcomes for UTUC after LND.


Methods :

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). Secondary outcome was recurrence free survival (RFS). Cox regression (CR), logistic regression (LR) and Kaplan−Meier (KMA) analyses were utilized.


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=7 and pN+=4 (p=0.22). On CR 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). On KMA, 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 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. On LR 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).


Conclusions :

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 yet considered in patients with clinical HG disease and increasing tumor size. Further investigation is requisite.

Ithaar Derweesh

Professor of Urology and Radiology Program Director, Urologic Oncology Fellowship
Department of Urology, University of California San Diego School of Medicine

Presentation(s):

    Send Email for Ithaar Derweesh

    Ryan Nasseri

    University of California San Diego

    Presentation(s):

      Send Email for Ryan Nasseri

      Zachary Hamilton

      University of California San Diego

      Presentation(s):

        Send Email for Zachary Hamilton

        Daniel Han

        University of California San Diego

        Presentation(s):

          Send Email for Daniel Han

          Stephen Ryan

          Urologic Oncology Fellow
          University of California San Diego

          Medical School: East Carolina University
          Residency: Maine Medical
          Fellowship: Uro/Onc UCSD

          Presentation(s):

            Send Email for Stephen Ryan

            Madhu Reddy

            Presentation(s):

              Send Email for Madhu Reddy

              Aaron Bloch

              University of California San Diego

              Presentation(s):

                Send Email for Aaron Bloch

                Fang Wan

                University of California San Diego

                Presentation(s):

                  Send Email for Fang Wan


                  Assets

                  MP23-1 - Utility of Lymph Node Dissection for Clinical Node Negative Upper Tract Urothelial Cell Carcinoma: A Multicenter Study



                  Attendees who have favorited this

                  Please enter your access key

                  The asset you are trying to access is locked. Please enter your access key to unlock.

                  Send Email for MP23-1 - Utility of Lymph Node Dissection for Clinical Node Negative Upper Tract Urothelial Cell Carcinoma: A Multicenter Study