Role of surgical approach on lymph node dissection yield and survival in patients with upper tract urothelial carcinoma

Andrew T Lenis; Nicholas M Donin; Izak Faiena; Amirali Salmasi; David C Johnson; Alexandra Drakaki; Kiran Gollapudi; Jeremy Blumberg; Arie Belldegrun; Allan Pantuck; Karim Chamie

doi:10.1016/j.urolonc.2017.09.001

Role of surgical approach on lymph node dissection yield and survival in patients with upper tract urothelial carcinoma

Urol Oncol. 2018 Jan;36(1):9.e1-9.e9. doi: 10.1016/j.urolonc.2017.09.001. Epub 2017 Oct 20.

Authors

Affiliations

¹ Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA.
² Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Hematology and Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA.
³ Division of Urology, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA.
⁴ Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA.
⁵ Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA. Electronic address: kchamie@mednet.ucla.edu.

PMID: 29066013
DOI: 10.1016/j.urolonc.2017.09.001

Abstract

Objectives: With increasing utilization of robot-assisted surgery in urologic oncology, robotic nephroureterectomy (RNU) is becoming the surgical modality of choice for patients with upper tract urothelial carcinoma (UTUC). The role of surgical approach on lymph node dissection (LND) and lymph node (LN) yield is unclear, and potential therapeutic effects are unknown. Here we analyze the effects of surgical approach on LN yield, performance of LND, and overall survival (OS).

Methods and materials: Patients with UTUC who underwent nephroureterectomy from 2010 to 2013 were identified in the National Cancer Database. Outcomes of interest included rate of LND, LN yield, and OS. Logistic regression analyses were used to predict performance of LND. Negative binomial regression was used to derive incidence rate ratios for LN yield. Cox proportional hazards models were used to quantify survival outcomes.

Results: A total of 3,116 patients met inclusion criteria. LND was performed in 41% (314/762) of RNU, 27% (380/1385) of LNU cases, and 35% (340/969) of ONU (P<0.001). Compared with an ONU, patients who underwent a LNU had significantly lower odds of receiving a LND (OR = 0.70, 95% CI: 0.55-0.87) and had fewer LNs removed (IRR = 0.69, 95% CI: 0.60-0.80), while RNU trended toward increased LN yield (IRR = 1.14, 95% CI: 0.98-1.33). In a Cox proportional hazards model, increasing LN yield was associated with improved OS in patients with pN0 disease (HR = 0.97 per 1 unit increase in LN yield, 95% CI: 0.95-0.99).

Conclusions: Compared with an ONU, RNU does not compromise performance of a LND and may be associated with improved LN yield. LNU is associated with the lowest rates of LND and LN yield. Increasing LN yield is associated with improved OS in patients with pN0 disease. Despite differential rates of LND and LN yield, surgical approach did not independently affect OS.

Keywords: Lymph node dissection; Nephroureterectomy; Outcomes; Upper urinary tract; Urothelial carcinoma.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Humans
Lymph Node Excision
Male
Survival Analysis
Treatment Outcome
Urologic Neoplasms / mortality
Urologic Neoplasms / pathology
Urologic Neoplasms / surgery*

Grants and funding

L30 CA154326/CA/NCI NIH HHS/United States