This study investigated the relapse pattern and oncologic outcomes after laparoscopic nephroureterectomy with template-based lymph node dissection (LND) in patients with clinically node-negative (cN0) upper urinary tract urothelial carcinoma. The frequency of lymph node metastasis, including micrometastases, was also evaluated.
A total of 105 patients with cTa-3N0M0 upper urinary tract urothelial carcinoma were analyzed, all of whom underwent regional LND during laparoscopic nephroureterectomy. Of those patients, 96 (91%) underwent complete LND in accordance with an anatomical template-based rule. We collected patient characteristics, pathological data, and follow-up data from medical charts. Micrometastases were assessed by pan-cytokeratin immunohistochemistry. Nonurothelial recurrence-free survival and cancer-specific survival were estimated using the Kaplan-Meier method.
The median number of lymph nodes removed was 12 (range, 1-59). Lymph node metastasis was identified by routine pathological examination in 7 (7/105, 6.7%) patients. Pan-cytokeratin immunohistochemistry revealed micrometastases in 5 additional patients (pNmicro +: 5/105, 4.8%). Nonurothelial disease recurrence was observed in 21 (20%) patients at a median of 10 months (range: 1-33) after surgery. Distant metastasis was dominant (15/105, 14.3%), followed by locoregional recurrence (5/105, 4.8%) and both (1/105, 0.95%). The 5-year nonurothelial recurrence-free survival rates were 84.8% for pN0, 53.3% for pNmicro+, and 19.1% for pN+ (3-sample log-rank test, P < 0.0001). The 5-year cancer-specific survival rates were 95.0% for pN0, 53.3% for pNmicro+, and 23.8% for pN+ (P < 0.0001).
Our observation showed that template-based LND could contribute to precise disease staging and better local disease control probably by eliminating nodal disease, compared with previous studies. The survival impact and ideal management of pNmicro+ disease should be evaluated in a larger cohort.
Urologic oncology. 2020 Jun 10 [Epub ahead of print]
Ryuji Matsumoto, Takashige Abe, Norikata Takada, Keita Minami, Toru Harabayashi, Satoshi Nagamori, Kanako C Hatanaka, Katsushige Yamashiro, Hiroshi Kikuchi, Takahiro Osawa, Satoru Maruyama, Nobuo Shinohara
Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan., Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan. Electronic address: ., Department of Urology, Hokkaido Cancer Center, Sapporo, Japan., Department of Urology, Sapporo City General Hospital, Sapporo, Japan., Clinical Research and Medical Innovation Center, Hokkaido University Hospital, Sapporo, Japan., Department of Pathology, Hokkaido Cancer Center, Sapporo, Japan.