Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal, Montréal, Québec, Canada; Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy.
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal, Montréal, Québec, Canada; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy Vita-Salute San Raffaele University, Milan, Italy.
Eur J Surg Oncol. 2019 Jul;45(7):1238-1245. doi: 10.1016/j.ejso.2018.12.004. Epub 2018 Dec 11.
To analyze lymph node invasion (LNI) rates according to tumor characteristics and to test the impact of LNI and its extent on cancer specific mortality (CSM) in surgically-treated non metastatic urothelial upper urinary tract carcinoma (UTUC) patients.
Within the SEER database (2004-2014), we identified 2098 patients with histologically confirmed non-metastatic urothelial carcinoma of renal pelvis or ureter who underwent NU with LND. LNI rates stratified according to tumor location and stage were described. Kaplan-Meier plots illustrated CSM rates according to LNI and its extent. Multivariable Cox regression models (MCRMs) tested the effect of LNI and its extent on CSM.
Of 2098 UTUC patients, who underwent nephroureterectomy with lymph node dissection, 646 (33%) had LNI. The median number of removed lymph nodes was 3 [Interquartile range (IQR): 1-7]. The median number of positive lymph nodes in patients, who harbored LNI was 1 (IQR:1-3). LNI rates according to tumor location were, respectively, 23.6% for ureteral and 36.5% for renal pelvis tumors. LNI rates according to tumor stage were 9.6, 18.0, 38.7 and 63.9%, for respectively, T1, T2, T3 and T4 UTUC. In MCRMs, LNI achieved independent predictor status for higher CSM (HR 3.00; p < 0.001). Finally, in MCRMs, number of positive lymph nodes defined as the 75th percentile (n ≥ 3) achieved independent predictor status for higher CSM (HR 1.37; p = 0.04).
LNI in non-metastatic UTUC patients is the most important determinant of CSM. Number of positive lymph node is independently associated with higher CSM. In consequence, lymph node dissection can provide extensive prognostic information.
分析肿瘤特征与淋巴结侵犯（LNI）率的关系，并检测 LNI 及其程度对接受淋巴结清扫术（LND）的非转移性尿路上皮上尿路尿路上皮癌（UTUC）患者的癌症特异性死亡率（CSM）的影响。
在 SEER 数据库（2004-2014 年）中，我们鉴定了 2098 例经组织学证实的非转移性肾盂或输尿管尿路上皮癌患者，这些患者接受了肾输尿管切除术加淋巴结清扫术（NU+LND）。根据肿瘤位置和分期描述 LNI 率。Kaplan-Meier 图根据 LNI 及其程度描绘了 CSM 率。多变量 Cox 回归模型（MCRM）检测了 LNI 及其程度对 CSM 的影响。
在接受肾输尿管切除术加淋巴结清扫术的 2098 例 UTUC 患者中，有 646 例（33%）存在 LNI。切除的淋巴结中位数为 3 [四分位距（IQR）：1-7]。存在 LNI 的患者中阳性淋巴结的中位数为 1（IQR：1-3）。根据肿瘤位置，输尿管肿瘤的 LNI 率分别为 23.6%，肾盂肿瘤为 36.5%。根据肿瘤分期，T1、T2、T3 和 T4 UTUC 的 LNI 率分别为 9.6%、18.0%、38.7%和 63.9%。在 MCRM 中，LNI 是 CSM 较高的独立预测因子（HR 3.00；p<0.001）。最后，在 MCRM 中，阳性淋巴结数量定义为第 75 百分位数（n≥3）是 CSM 较高的独立预测因子（HR 1.37；p=0.04）。
非转移性 UTUC 患者的 LNI 是 CSM 的最重要决定因素。阳性淋巴结数量与 CSM 较高独立相关。因此，淋巴结清扫术可以提供广泛的预后信息。
