(UroToday.com) The 2022 EAU annual meeting featured a session on new insights in the management of upper tract urothelial cancer, including a presentation by Dr. Kevin Hakimi discussing the impact of node count on survival outcomes of lymph node dissection in non-metastatic upper tract urothelial carcinoma. The utility of lymph node dissection in localized upper tract urothelial carcinoma is controversial, thus this study evaluated the impact of lymph node count on survival outcomes in patients with non-metastatic upper tract urothelial carcinoma using a multi-institutional database.
This study retrospectively analyzed the ROBUUST (RObotic surgery for Upper Tract Urothelial Cancer Study) registry of patients undergoing robotic nephroureterectomy with clinical node-negative disease (cN0). The cohort was divided into the following groups:
- Patients who did not undergo lymph node dissection (pNx)
- Patients who underwent lymph node dissection with <10 negative lymph nodes removed (pN0<10)
- Patients with ≥10 negative lymph nodes removed (pN0≥10)
The primary outcome was recurrence-free survival (RFS), and secondary outcomes were overall survival (OS) and cancer-specific survival (CSS). Multivariable analyses were conducted for predictors of survival outcomes and lymph node positivity, and Kaplan-Meier analyses were used to compare survival outcomes based on the number of nodes removed.
There were 790 patients analyzed, of which 315 (39.9%) underwent lymph node dissection, with a median follow up 20 months. Comparing pNx, pN0<10, and pN0≥10 patients, no significant differences were noted for high grade disease (p=0.091), tumor size (p=0.182), and multifocality (p=0.176). Of note, pN0≥10 had lower incidence of recurrence (pNx 30.7%, pN0<10 32.7%, pN0≥10 18.9%; p=0.029). The multivariable analysis noted pN0≥10 (HR 0.77, p=0.029) was associated with decreased risk of recurrence, while multifocality (HR 1.62, p=0.003) was associated with increased risk. However, nodal count was not independently associated with all-cause (p=0.704) and cancer-specific mortality (p=0.118). Predictors for lymph node positivity on multivariable analysis were high-grade disease (OR 12.1, p=0.014) and tumor size >4.5cm (OR 2.12, p=0.005). Kaplan-Meier analyses comparing survival outcomes of pNx, pN0<10, and pN0≥10 groups demonstrated improved 5-year RFS with pN0≥10 (73% vs. pN0<10 47% vs. pNx 39%; p = 0.044):
No differences were noted in 5-year OS (pN0≥10 83% vs. pN0<10 70% vs. pNx of 70%, p=0.854) and 5-year CSS (pN0≥10 22%, pN0<10 26% vs. pNx 22%, p = 0.443).
Dr. Hakimi concluded his presentation discussing the impact of node count on survival outcomes of lymph node dissection in non-metastatic upper tract urothelial carcinoma with the following concluding statements:
- Performance of lymph node dissection with ≥10 nodes was associated with reduced risk of recurrence and improved RFS
- Further investigation is requisite into impact of lymph node yield and for standardization of lymph node dissection templates to optimize outcomes in non-metastatic upper tract urothelial carcinoma
Presented by: Kevin Hakimi, MS4, UC San Diego School of Medicine, Department of Urology, La Jolla, United States of America
Co-Authors: Carbonara U.2, Djaladat H.3, Mehrazin R.4, Eun D.5, Reese A.5, Gonzalgo M.6, Margulis V.7, Uzzo R.8, Porter J.9, Sundaram C.10, Abdollah F.11, Mottrie A.12, Tellini R.13, Ferro M.14, Meagher M.1, Saidian A.1, Walia A.1, Veccia A.2, Ghoriefi A.3, Cacciamani G.3, Bhattu A.5, Minervini A.13, Autorino R.2, Derweesh I.1
Affiliations: 1UC San Diego School of Medicine, Dept. of Urology, La Jolla, United States of America, 2VCU Health, Dept. of Urology, Richmond, United States of America, 3Keck School of Medicine, Dept. of Urology, Los Angeles, United States of America, 4Mount Sinai Hospital, Dept. of Urology, New York, United States of America, 5Temple University, Dept. of Urology, Philadelphia, United States of America, 6University of Miami, Dept. of Urology, Miami, United States of America, 7UT Southwestern Medical Center, Dept. of Urology, Houston, United States of America, 8Moffitt Cancer Center, Dept. of Urology, Tampa, United States of America, 9Swedish Medical Center, Dept. of Urology, Seattle, United States of America, 10Indiana University Health, Dept. of Urology, Indianapolis, United States of America, 11Henry Ford Health System, Dept. of Urology, Detroit, United States of America, 12OLV Hospital, Dept. of Urology, Aalst, Belgium, 13University of Florence, Dept. of Urology, Florence, United States of America, 14European Institute of Oncology, Dept. of Urology, Rome, Italy
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, @zklaassen_md on Twitter during the 2022 European Association of Urology (EAU) Annual Hybrid Meeting, Amsterdam, NL, Fri, July 1 – Mon, July 4, 2022.