Raza Syed Johar, Miller Caleb, May Allison, Davaro Facundo, Siddiqui Sameer Ahmed, Hamilton Zachary
Division of Urology, Department of Surgery, Saint Louis University, St Louis, Missouri, USA.
Can J Urol. 2019 Aug;26(4):9852-9858.
The use of lymph node density (LND) as a predictor of survival outcomes has been studied with urothelial carcinoma of the bladder. Similar results can be postulated to upper tract urothelial carcinoma (UTUC). This study aims to determine the overall survival of patients with lymph node positive UTUC based on LND, utilizing the National Cancer Database (NCDB).
Data was derived from NCDB Participant User Kidney Dataset using the histology code 'transitional cell carcinoma', utilizing pN+ patients from 2004-2015. LND was calculated as number of positive nodes divided by total number of nodes removed. Patients were stratified by traditional AJCC pN stage and compared to LND groups (< 30%, ≥ 30%). Primary outcome was overall survival. Kaplan-Meier and Cox regression analyses were performed.
A total of 2049 patients were identified (pN1 = 1022, pN2 = 1027; LND < 30% = 370, ≥ 30% = 1679). Mean LND was 71%. Cox regression for mortality using pN stage was not significant (p = 0.11); however, Cox regression for mortality using LND group noted significantly worsened survival with LND ≥ 30% (HR 1.54, p = 0.001). Kaplan Meier analysis for overall survival at 2 years showed no difference between pN1 and pN2 stages (35.3% versus 34.1%; log rank p = 0.37). Kaplan Meier analysis for overall survival at 2 years revealed significant difference between LND groups (LND < 30%, 47.3% versus LND ≥ 30%, 32.0%; log rank p < 0.001).
LND provides improved prognostic information regarding overall survival, compared to traditional AJCC pN staging. Future studies need to evaluate LND to improve prognostic understanding of lymph node positive UTUC.
淋巴结密度（LND）作为生存结果预测指标已在膀胱尿路上皮癌中进行了研究。上尿路尿路上皮癌（UTUC）可能会有类似结果。本研究旨在利用国家癌症数据库（NCDB）确定基于LND的淋巴结阳性UTUC患者的总生存期。
数据来自NCDB参与者用户肾脏数据集，使用组织学代码“移行细胞癌”，选取2004年至2015年的pN+患者。LND计算为阳性淋巴结数除以切除的淋巴结总数。患者按传统AJCC pN分期分层，并与LND组（<30%，≥30%）进行比较。主要结局为总生存期。进行了Kaplan-Meier和Cox回归分析。
共确定2049例患者（pN1 = 1022，pN2 = 1027；LND < 30% = 370，≥ 30% = 1679）。平均LND为71%。使用pN分期进行的Cox死亡率回归不显著（p = 0.11）；然而，使用LND组进行的Cox死亡率回归显示，LND≥30%时生存明显恶化（HR 1.54，p = 0.001）。2年总生存期的Kaplan-Meier分析显示，pN1和pN2分期之间无差异（35.3%对34.1%；对数秩p = 0.37）。2年总生存期的Kaplan-Meier分析显示，LND组之间存在显著差异（LND < 30%为47.3%，LND≥30%为32.0%；对数秩p < 0.001）。
与传统AJCC pN分期相比，LND提供了关于总生存期的更好预后信息。未来研究需要评估LND，以改善对淋巴结阳性UTUC的预后理解。
