1. Prognostic Value of Extranodal Extension and Other Lymph Node Parameters in Patients With Upper Tract Urothelial Carcinoma
- Author
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Jay D. Raman, Thomas F. Chromecki, Eugene K. Cha, Christian Seitz, Gerhard Donner, Harun Fajkovic, Claudio Jeldres, Karim Bensalah, Vitaly Margulis, Armin Pycha, Mesut Remzi, Giacomo Novara, Alon Z. Weizer, Yair Lotan, Wassim Kassouf, Vincenzo Ficarra, Kazumasa Matsumoto, Eiji Kikuchi, Francesco Montorsi, Marco Roscigno, Pierre I. Karakiewicz, Douglas S. Scherr, Eckart Breinl, Shahrokh F. Shariat, Weill Medical College of Cornell University [New York], Cancer Prognostics and Health Outcomes Unit, Université de Montréal (UdeM), Department of Urology, University of Texas Southwestern Medical Center [Dallas]- The University of Texas Health Science Center at Houston (UTHealth), Departement of Oncological and Surgical Sciences, Universita degli Studi di Padova, Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], University of Michigan [Ann Arbor], University of Michigan System, Keio University School of Medicine [Tokyo, Japan], Hospital Weinviertel-Korneuburg-Landesklinikum Korneuburg, General Hospital of Bolzano, Health Robotics S.r.l., Department of urology, Università Vita-Salute San Raffaele, Service d'urologie [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Fajkovic, Harun, Cha Eugene, K., Jeldres, Claudio, Donner, Gerhard, Chromecki Thomas, F., Margulis, Vitaly, Novara, Giacomo, Lotan, Yair, Raman Jay, D., Kassouf, Wassim, Seitz, Christian, Bensalah, Karim, Weizer, Alon, Kikuchi, Eiji, Roscigno, Marco, Remzi, Mesut, Matsumoto, Kazumasa, Breinl, Eckart, Pycha, Armin, Ficarra, Vincenzo, Montorsi, Francesco, Karakiewicz Pierre, I., Scherr Douglas, S., and Shariat Shahrokh, F.
- Subjects
Male ,Oncology ,MESH: Chi-Square Distribution ,urothelial carcinoma carcinoma ,MESH: Lymphatic Metastasis ,medicine.medical_treatment ,030232 urology & nephrology ,carcinoma ,Nephrectomy ,lymph node excision ,[SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology ,MESH: Proportional Hazards Models ,neoplasm metastasis ,0302 clinical medicine ,Risk Factors ,MESH: Risk Factors ,MESH: Ureteral Neoplasms ,Stage (cooking) ,Lymph node ,Neoadjuvant therapy ,MESH: Treatment Outcome ,MESH: Statistics, Nonparametric ,MESH: Follow-Up Studies ,MESH: Neoplasm Staging ,Prognosis ,MESH: Urinary Bladder Neoplasms ,3. Good health ,Treatment Outcome ,medicine.anatomical_structure ,Chemotherapy, Adjuvant ,MESH: Chemotherapy, Adjuvant ,Lymphatic Metastasis ,030220 oncology & carcinogenesis ,Female ,[SDV.IB]Life Sciences [q-bio]/Bioengineering ,Lymph ,Radiology ,MESH: Neoplasm Recurrence, Local ,medicine.medical_specialty ,Urology ,urinary tract ,urothelium ,Statistics, Nonparametric ,MESH: Prognosis ,03 medical and health sciences ,Internal medicine ,medicine ,Carcinoma ,Humans ,Neoplasm Staging ,Proportional Hazards Models ,Retrospective Studies ,Chi-Square Distribution ,MESH: Humans ,Ureteral Neoplasms ,MESH: Lymph Node Excision ,business.industry ,Carcinoma in situ ,MESH: Retrospective Studies ,Retrospective cohort study ,medicine.disease ,MESH: Male ,MESH: Nephrectomy ,Urinary Bladder Neoplasms ,Neoplasm Recurrence, Local ,business ,MESH: Female ,Follow-Up Studies - Abstract
International audience; PURPOSE: We assessed the prognostic value of extranodal extension and other lymph node parameters in a large multicenter cohort of patients with lymph node metastasis after radical nephroureterectomy. MATERIALS AND METHODS: We retrospectively analyzed the records of 222 patients with lymph node metastasis treated with radical nephroureterectomy for upper tract urothelial carcinoma without neoadjuvant therapy. Each lymph node metastasis was microscopically evaluated for extranodal extension. RESULTS: A median of 4 lymph nodes (IQR 8) was removed. Two lymph nodes (IQR 2) were positive. Lymph node density was 51.3% (IQR 71.7%). Overall 110 patients (49.5%) had extranodal extension, which was associated with more advanced pT stage (p = 0.026). On multivariable analysis extranodal extension was associated with disease recurrence (p = 0.01) and cancer specific mortality (p = 0.013). When stratified by a 30% cutoff, lymph node density was associated with disease recurrence and cancer specific mortality on univariable but not multivariable analysis (p = 0.048 and 0.049, respectively). Adding extranodal extension to a multivariable model including pT stage and tumor architecture improved predictive accuracy for disease recurrence from 70.3% to 74.5% (p
- Published
- 2012