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      Effect of lymph node dissection on stage-specific survival in patients with upper urinary tract urothelial carcinoma treated with nephroureterectomy

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          Abstract

          Background

          We aimed to estimate the stage-specific impact of lymph node dissection (LND) on survival for upper urinary tract urothelial carcinoma (UTUC) patients treated with nephroureterectomy (NU).

          Methods

          Overall, 7278 UTUC patients undergoing NU within the SEER database from 2004 to 2015 were identified. Kaplan-Meier plots illustrated overall survival (OS) and cancer-specific survival (CSS) rates according to LND status. Multivariable Cox regression analyses assessed the effect of LND on OS and CSS rates stratified by pathological tumor stage.

          Results

          LND was performed in 26.9% of patients, and in 18.6, 23.3, 31.2 and 45.9% for pT1, pT2, pT3 and pT4 patients, respectively ( P <  0.001). In multivariable Cox regression analyses, LND was associated with a higher OS or CSS in UTUC patients with pT3 and pT4 disease (all P <  0.05), but failed to achieve independent predictor status in patients with pT1 and pT2 disease (all P > 0.05). LND with 1 to 3 regional lymph nodes removed was prone to a higher OS or CSS only in pT4 compared to no LND (both P <  0.01). LND with 4 or more regional lymph nodes removed predisposed to a higher OS or CSS in pT3 or pT4 (all P <  0.05).

          Conclusions

          The beneficial effect of LND especially LND with 4 or more regional lymph nodes removed on survival was evident in pT3/4 patients. LND can be considered for pT3 and pT4, for pT1/2 remains to be seen, both of which will be verified by further prospective studies.

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          Most cited references19

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          Extended Versus Limited Lymph Node Dissection in Bladder Cancer Patients Undergoing Radical Cystectomy: Survival Results from a Prospective, Randomized Trial

          The extent of lymph node dissection (LND) in bladder cancer (BCa) patients at the time of radical cystectomy may affect oncologic outcome.
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            Lymphadenectomy at the time of nephroureterectomy for upper tract urothelial cancer.

            The role of lymph node dissection (LND) in patients treated with radical nephroureterectomy (RNU) for upper tract urothelial cancer (UTUC) is still controversial.
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              A critical appraisal of the value of lymph node dissection at nephroureterectomy for upper tract urothelial carcinoma.

              To perform a population-based analysis of the potential staging or prognostic value (or both) of lymph node dissection (LND) in patients without nodal metastases vs no LND. In several previous reports, LND in patients with upper tract urothelial carcinoma (UTUC) treated with nephroureterectomy (NU) was associated with better survival relative to no LND (pN(x)), even in the absence of pathologically confirmed nodal metastases (pN(0)). Within the surveillance, epidemiology, and end results database, we identified 2824 patients treated with NU for UTUC between 1988 and 2004. CSM rates after NU were graphically explored using Kaplan-Meier plots. Univariable and multivariable Cox regression models tested the effect of N(0) vs N(x) stage on CSM, after adjusting for T stage, tumor grade, age, gender, primary tumor location, type, and year of surgery. The CSM-free survival rate at 5 years after NU was 81.2% and 77.8% respectively for pN(0) and pN(x) patients. In univariable analyses pN(x) vs pN(0) status was not associated with worse survival (HR: 1.19; P = .09). After adjustment for all covariates, pN(x) vs pN(0) status still failed to achieve independent predictor status (HR: 0.99; P = .9). We found no survival benefit related to the performance of LND in pN(0) patients, relative to pN(x) patients. Lack of standardized criteria for patients' selection for LND and for pathological lymph node specimen evaluation represents some of the explanation for the observed discrepancy between the current finding and previous findings. Crown Copyright 2010. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Contributors
                yaoxudong67@sina.com
                2357538246@qq.com
                ericyelin@163.com
                Journal
                BMC Cancer
                BMC Cancer
                BMC Cancer
                BioMed Central (London )
                1471-2407
                12 December 2019
                12 December 2019
                2019
                : 19
                : 1207
                Affiliations
                [1 ]ISNI 0000 0004 0527 0050, GRID grid.412538.9, Department of Urology, , Shanghai Tenth People’s Hospital of Tongji University, School of Medicine, ; Shanghai, 200072 China
                [2 ]Department of Urology, Shawan People’s Hospital, Shawan, Xinjiang 832100 China
                [3 ]ISNI 0000 0000 9255 8984, GRID grid.89957.3a, Nanjing Medical University, ; Nanjing, 210000 China
                [4 ]ISNI 0000000123704535, GRID grid.24516.34, Department of Urology, , Shanghai Putuo District People’s Hospital of Tongji University, School of Medicine, ; Shanghai, 200333 China
                [5 ]GRID grid.459690.7, Department of Urology, , Karamay Central Hospital, ; Karamay, Xinjiang, 834000 China
                Article
                6364
                10.1186/s12885-019-6364-z
                6907152
                31830927
                7fa5eaea-d34f-428f-9b1d-1269cc7cf801
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 3 June 2019
                : 15 November 2019
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Award ID: No. 81672549
                Award ID: 81972409
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/100007219, Natural Science Foundation of Shanghai;
                Award ID: No. 15ZR1433000
                Award Recipient :
                Funded by: Karamay Municipal Science and Technology Foundation
                Award ID: No. JK2017-5
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Oncology & Radiotherapy
                lymph node dissection,neoplasm staging,seer program,survival analysis,upper urinary tract urothelial carcinoma

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