(UroToday.com) The 37th Annual European Association of Urology Congress held in Amsterdam, Netherlands between July 1st,and 4th 2022 was host to an abstract session regarding new insights in the management of upper tract urothelial cancer (UTUC). Dr. Firas Abdollah and Austin Piontkowski presented results from the National Cancer Database (NCDB) evaluating the role of lymph node dissection (LND) in UTUC patients with cN+ disease.
The authors began their presentation by noting that the benefits of LND in cN+ patients with UTUC undergoing a radical nephroureterectomy (RNU) remain unknown. Thus, the objective of this study was to evaluate whether LND at time of RNU in cN+ patients was associated with any survival benefits.
Using the NCDB, the authors identified 423 cN+ patients between 2004 and 2016 with UTUC undergoing RNU. Of the 423 patients, 310 (73.3%) received an LND. The association between LND and survival outcomes was assessed using Kaplan-Meier survival plots and cox proportional hazards regression analyses.
Median patient age was 68 years (IQR: 61 – 76) and 56.7% were male. cN1, cN2, and cN3 disease was present in 50.4%, 46.5% and 3.07%, respectively. Median follow-up was 1.8 years. Kaplan-Meier survival analysis demonstrated no significant differences in overall 2-year survival (52.1% with LND and 51.1% without LND, log-rank test, p=0.2).
These results did not differ when patients were stratified by cN status (cN1 and cN2/3):
On multivariable cox regression analysis, undergoing a LND was not associated with significant differences in survival outcomes:
- Overall cohort: HR=0.93 (p=0.9)
- cN1: HR=0.76 (p=0.26)
- cN2/3: HR=0.84 (p=0.43)
The authors concluded that LND in patients with cN+ UTUC disease undergoing RNU was not associated with improvement in OS on both univariable and multivariable analyses, although most patients with cN+ disease receive a LND as per results from the NCDB. Regardless of decision for LND, these patients have poor survival outcomes with two- and five-year OS of 50% and 25%, respectively.
Presented by: Austin J. Piontkowski, Medical Student, Wayne State University, Detroit MI
Dr. Firas Abdollah, MD, Clinical Associate Professor, Vice-Chair, Academics and Research, Vattikuti Urology Institute, Department of Urology, Henry Ford Hospital, Detroit, MI
Written by: Rashid Sayyid, MD, MSc – Society of Urologic Oncology (SUO) Clinical Fellow at The University of Toronto, @rksayyid on Twitter during the 2022 European Association of Urology (EAU) Annual Hybrid Meeting, Amsterdam, NL, Fri, July 1 – Mon, July 4, 2022.