Risk stratification of patients with nodal involvement in upper tract urothelial carcinoma: value of lymph-node density
Bolenz, Christian; Shariat, Shahrokh F.; Fernández, Mario I.; Margulis, Vitaly; Lotan, Yair; Karakiewicz, Pierre I.; Remzi, Mesut; Kikuchi, Eiji; Zigeuner, Richard; Weizer, Alon Z.; Montorsi, Francesco; Bensalah, Karim; Wood, Christopher G.; Roscigno, Marco; Langner, Cord; Koppie, Theresa M.; Raman, Jay D.; Mikami, Shuji; Michel, Maurice Stephan; Ströbel, Philipp
2009-02
Citation
Bolenz, Christian; Shariat, Shahrokh F.; FernÁndez, Mario I.; Margulis, Vitaly; Lotan, Yair; Karakiewicz, Pierre; Remzi, Mesut; Kikuchi, Eiji; Zigeuner, Richard; Weizer, Alon; Montorsi, Francesco; Bensalah, Karim; Wood, Christopher G.; Roscigno, Marco; Langner, Cord; Koppie, Theresa M.; Raman, Jay D.; Mikami, Shuji; Michel, Maurice Stephan; StrÖbel, Philipp (2009). "Risk stratification of patients with nodal involvement in upper tract urothelial carcinoma: value of lymph-node density." BJU International 103(3): 302-306. <http://hdl.handle.net/2027.42/75412>
Abstract
To determine the risk factors associated with clinical outcome in patients with lymph node (LN)-positive urothelial carcinoma of the upper urinary tract (UTUC) treated with radical nephroureterectomy (RNU) and lymphadenectomy, focusing on the concept of LN density (LND). PATIENTS AND METHODS Patients undergoing RNU with regional lymphadenectomy were identified through multi-institutional databases. All pathology slides were re-evaluated by genitourinary pathologists unaware of the clinical data. The exposure variable used was LND (continuously coded and that of all possible thresholds) with recurrence-free and disease-specific survival (DSS) serving as the outcome measures. RESULTS Of 432 patients undergoing RNU with lymphadenectomy, 135 (31%) had LN metastases. Within a median follow-up of 4.1 years, 90 of the 135 patients with LN metastases (68%) had disease recurrence and 76 (58%) died from UTUC. The mean (sem) 5-year recurrence-free and DSS probabilities were 27 (4)% and 33 (5)%, respectively. The median (range) LND was 50 (3–100)%. The most informative threshold for LND in relation to outcome was 30%. In multivariable analyses that adjusted for the effects of tumour stage and grade, patients with a LND of ≥30% were at greater risk of both cancer recurrence, with 5-year rates of 25 (5)% vs 38 (8)% (hazard ratio 1.8, P = 0.021) and mortality, with 5-year rates of 30 (6)% vs 48 (9)% (1.7, P = 0.032) compared to those with a LND of <30%. Our results are primarily limited by a lack of standardization in the lymphadenectomy template. CONCLUSION We evaluated the concept of LND for the first time in UTUC. LND provides additional prognostic information in patients with node-positive disease after RNU. The use of LND in clinical trials might provide an additional insight into the value of LN dissection in patients undergoing RNU.Publisher
Blackwell Publishing Ltd
ISSN
1464-4096 1464-410X
Other DOIs
PMID
18990164
Types
Article
URI
http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=retrieve&db=pubmed&list_uids=18990164&dopt=citationMetadata
Show full item recordRemediation of Harmful Language
The University of Michigan Library aims to describe library materials in a way that respects the people and communities who create, use, and are represented in our collections. Report harmful or offensive language in catalog records, finding aids, or elsewhere in our collections anonymously through our metadata feedback form. More information at Remediation of Harmful Language.
Accessibility
If you are unable to use this file in its current format, please select the Contact Us link and we can modify it to make it more accessible to you.