AUA 2017: Distribution of Lymph Node Metastasis in Upper Urinary Tract Urothelial Cancer, Sub-Analysis of JCOG1110A Study
The authors included 1,932 patients with non-metastatic UTUC who underwent radical nepheroureterectomy (RUN) in the JCOG1110A study, including 30 institutions between 1995 to 2009. The indication and extent of lymphadenectomy were determined by each surgeon, and anatomical locations of the primary tumor and number of patients with positive lymph nodes in each lymph node region were analyzed. In the cohort, 188 (9.7%) had pathologic lymph node positivity. On the right side, primary tumor was documented in the renal pelvis (n=51), upper ureter (n=2), mid-ureter (n=7), and lower ureter (n=20). Similarly, on the left, the distribution was: renal pelvis (n=76), upper ureter (n=5), mid-ureter (n=9), and lower ureter (n=18). Distribution of lymph node metastasis for upper ureteral cancer was similar to the renal pelvis, and for mid-ureteral tumors was similar to lower ureteral tumors. On right side, upper UTUC had metastasis to renal hilar (59%), paracaval (23%) and interaortocaval (13%) regions. Right-sided lower UTUC tumors had metastasis to the common iliac (22%), obturator (33%), external (19%) and internal iliac (11%) regions. On left side, upper UTUC tumors had metastasis to the renal hilar (54%), paraaortic (37%), interaortocaval (5%) regions. Lower UTUC tumors metastases to the common iliac (19%), obturator (26%), external (11%) and internal iliac (7%) regions, in addition to the renal hilar (11%) and paraaortic (26%) regions. The strength of this study is the multi-center collaboration with adequate sample size to describe lymph node drainage patterns.
This study elegantly describes in detail the lymph node drainage pattern of UTUC, helping to assist with template lymphadenectomy, particularly for lower UTUC primary tumors.
Speaker: Junichi Inokuchi, Kyushu University, Fukuoka, Japan
Co-Authors: Kentaro Kuroiwa, Yoshiyuki Kakehi, Mikio Sugimoto, Toshiki Tanikawa, Hiroyuki Fujimoto, Momokazu Gotoh, Naoya Masumori, Osamu Ogawa, Masatoshi Eto, Chikara Ohyama, Akito Yamaguchi, Hideyasu Matsuyama, Tomohiko Ichikawa, Tomohiko Asano, Atsushi Takenaka, Kiyohide Fujimoto, Raizo Yamaguchi, Tomonori Habuchi, Katsuyoshi Hashine, Yoichi Arai, Norihiko Tsuchiya, Hiroyuki Nishiyama, Nobuo Shinohara, Masashi Niwakawa, Shin Egawa, Seiichiro Ozono, Tomomi Kamba, Osamu Ishizuka, Kazuo Nishimura, Tatsuo Tochigi, Yoshiki Sugimura, Junki Mizusawa, Kenichi Miyamoto, Seiji Naito
Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre
Twitter: @zklaassen_md
at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA