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©The Author(s) 2015.
World J Clin Oncol. Dec 10, 2015; 6(6): 237-251
Published online Dec 10, 2015. doi: 10.5306/wjco.v6.i6.237
Published online Dec 10, 2015. doi: 10.5306/wjco.v6.i6.237
Table 1 The incidence of primary nodal involvement in each lymph node sites according to the location of the tumor in urothelial carcinomas of the upper urinary tract
Location of the primary tumor (No. of patients with nodal metastasis) | Ipsilateral | Ipsilateral | ||||||||||
Suprahilar | Ipsilateral renal hilar | Para-caval | Retro-caval | Interaorto-caval | Para-aortic | Common iliac | External iliac | Obturator | Internal iliac | Presacral | ||
Right | RP (22) | - | 14 (84%) | 8 (36%) | 9 (41%) | 3 (14%) | - | - | - | - | - | |
UU (3) | - | 1 (33%) | - | 1 (33%) | 2 (66%) | - | - | - | - | - | ||
MU (5) | - | - | - | 1 (20%) | 4 (80%) | - | - | - | - | - | ||
LU (7) | - | - | - | - | - | - | 4 (57%) | 1 (14%) | 5 (71%) | 2 (29%) | 1 (14%) | |
Left | RP (25) | - | 20 (80%) | - | - | 1 (4%) | 11 (44%) | - | - | - | - | |
UU (0) | - | - | - | - | - | - | - | - | - | - | ||
MU (5) | - | - | - | - | - | 5 (100%) | - | - | - | - | ||
LU (8) | - | - | - | - | - | - | 4 (50%) | 2 (25%) | 3 (38%) | 1 (13%) |
Table 2 Reports on staging benefit of lymphadenectomy in urothelial carcinoma of the upper urinary tract
Authors | Year | Institute | Template of LND | Subject | No. of patients | Results | Staging benefits | Ref. |
Roscigno | 2009 | Multi | Not well described | ≥ pT1 | 1130 | 5 yr-CSS: pN0 77% > pNx 69% (P = 0.032) > pN+ 35% (P < 0.001) | Yes | [29] |
≥ pT2 | 813 | 5 yr-CSS: pN0 70% > pNx 58% (P = 0.017) > pN+ 33% (P < 0.001) | ||||||
Abe | 2010 | Multi | Not well described | pT1 | 66 | RFS: pN0 = pNx (P = 0.702) | Yes | [30] |
≥ pT2 | 227 | RFS: pN0 > pNx (P < 0.001) = pN+ (P = 0.134) | in ≥ pT2 | |||||
Burger | 2011 | Multi | Not well described | Organ-confined | 519 | CSS: pN0 = pNx = pN+ | Yes | [32] |
In locally advanced disease | ||||||||
Locally advanced | 266 | CSS: pN0 = pNx (P = 0.633) > pN+ (P < 0.001) | ||||||
Lughezzani | 2010 | Multi | Not described | pT1, pT2 | 1324 | CSS: T1 pN0 = pNx (P = 0.4) = pN+ (P = 0.1) | Yes | [31] |
T2 pN0 = pNx (P = 0.8) = pN+ (P = 0.1) | In ≥ pT3 | |||||||
pT3, pT4 | 1382 | CSS: T3 pN0 = pNx (P = 0.9) > pN+ (P < 0.001) | ||||||
T4 pN0 = pNx (P = 0.3) > pNx (P < 0.001) | ||||||||
Mason | 2012 | Multi | Not described | All patients | 1029 | OS: pN0 66.1% = pNx 66.0% (P = 0.617) | Yes | [33] |
> pN+ 22.3% (P < 0.01) | ||||||||
Ouzzane | 2013 | Multi | Not described | All patients | 714 | 5 yr-CSS: pN0 81% = pNx 85% (P = 0.6) | Yes | [34] |
> pN+ 47% (P < 0.001) | but in T1 | |||||||
≥ pT2 | 337 | CSS: pN0 = pNx (P = 0.44) = pN+ (P < 0.15) | ||||||
TWMU | 2015 | Single | Well described | All patients | 314 | 5 yr-CSS: pN0 84% > pNx 70% (P = 0.02) | Yes | - |
> pN+ 31% (P < 0.001) | ||||||||
≥ pT2 | 212 | 5 yr-CSS: pN0 79% > pNx 59% (P < 0.007) | ||||||
> pN+ 31% (P < 0.004) |
Table 3 Reports on therapeutic benefit of lymphadenectomy in urothelial carcinoma of the upper urinary tract
Authors | Year | Institute | Property | Template of LND | Subject | No. of patients | Survival results | Independent factors in Multivariate analysis? | Therapeutic benefit? | Ref. |
Kondo | 2007 | Single | Retrospective | Clearly described | All patients | 169 | CSS: CompLND = IncompLND = No-LND (P = 0.06) | Yes: CompLND for CSS | Yes | [35] |
≥ pT3 | 88 | CSS: CompLND > No-LND (P = 0.01) | In ≥ pT3 | |||||||
Kondo | 2012 | Single | Retrospective | Clearly described | ≥ pT2 | 191 | 5 yr-CSS: CompLND 77.9% > IncompLND 54.0% = No-LND 59.0% (P = 0.03) | Not determined | Yes | [23] |
≥ pT3 | 140 | 5 yr-CSS: CompLND 73.2% > IncompLND 43.7% = No-LND 47.3% (P = 0.01) | In ≥ pT2 | |||||||
Brausi | 2007 | Single | Retrospective | Described | ≥ pT2 | 82 | DFS: RPLN 81.6% > No-LND 44.8% (P = 0.007) | Yes: RPLD for OS | Yes | [36] |
in ≥ pT2 | ||||||||||
Roscigno | 2008 | Single | Retrospective | Described | ≥ pT2 | 132 | 5 yr-CSS: LND 57% > No-LND 40% | Yes: LND and pN0 for CSS | Yes | [28] |
(P = 0.01) | in ≥ pT2 | |||||||||
pN0 72% > pNx 39% (P < 0.001) | ||||||||||
≥ pT2pN0 | 95 | 7 LNs > less than 7 (P < 0.001) | Yes: No. of LNs for CSS | Yes | ||||||
In ≥ 7 LNs removed | ||||||||||
Roscigno | 2009 | Multi | Retrospective | Not well described | ≥ pT2 | 1130 | 5 yr-CSS: LND 66% = No-LND 69% (P = 0.23) | Yes: pN0 for CSS | No | [29] |
Roscigno | 2009 | Multi | Retrospective | Not well described | ≥ pT1pN0 | 412 | 5y-CSS: 8 LNs or more 84% > less than 8 73% (P = 0.038) | Yes: No. of LNs for CSS | Yes in ≥ 8 LNs removed | [37] |
Abe | 2010 | Multi | Retrospective | Not well described | All patients | 293 | RFS: pN0 > pNx (P < 0.001) > pN+ (P = 0.004) | Yes: pNx of RFS | Yes | [30] |
Burger | 2011 | Multi | Retrospective | Not well described | Organ-confined | 519 | CSS: pN0 = pNx | No | Yes but limited only in locally advanced disease | [32] |
Locally advanced | 266 | CSS: pN0 = pNx (P = 0.633) | Yes: pN0 for CSS in locally advanced | |||||||
Lughezzani | 2010 | Multi | Retrospective | Not described | All patients | 2824 | No; CSS is pN0 = pNx | No | No | [31] |
Mason | 2012 | Multi | Retrospective | Not described | All patients | 1029 | OS: pN0 66.1% = pNx 66.0% (P = 0.617) | No | No | [33] |
Ouzzane | 2013 | Multi | Retrospective | Not described | All patients | 714 | 5y-CSS: pN0 81% = pNx 85% (P = 0.6) > pN+ 47% (P < 0.001) | No | No | [34] |
≥ pT2 | 337 | CSS: pN0 = pNx (P = 0.44) = pN+ (P < 0.15) | ||||||||
Kondo | 2014 | Multi | Prospective | Clearly described | Renal pelvis | 90 | ≥ pT2 | Yes in CSS in > pT2 | Yes in renal pelvic cancer in ≥ pT2 | [23] |
3 yr-OS: LND 86% > No-LND 48% (P = 0.01) | ||||||||||
3 yr-CSS: LND 89% > No-LND 51% (P = 0.01) | ||||||||||
3 yr-DFS: LND 77% > No-LND50% (P = 0.06) | ||||||||||
Ureter | 76 | ≥ pT2 | No | |||||||
3 yr-OS: LND 46% = No-LND 71% (P = 0.57) | ||||||||||
3 yr-CSS: LND 54% = No-LND 71% (P = 0.99) | ||||||||||
3 yr-DFS: LND 54% = No-LND 59% (P = 0.79) |
Table 4 Perioperative complications of the template-based lymphadenectomy and the no lymphadenectomy group
Template-based lymphadenectomy (77 patients) | No lymphadenectomy (89 patients ) | |||
Morbidity | n | Morbidity | n | |
Grade 1 | Grade 1 | |||
Numbness of thigh | 2 | Atelectasis | 1 | |
lymphorrhea | 1 | Delirium | 2 | |
Wound infection | 1 | Wound infection | 2 | |
Grade 2 | Lymphorrhea | 1 | ||
Chylous leakage | 1 | Subcutaneous hematoma | 1 | |
Retroperitoneal abscess | 1 | Grade 2 | ||
Lymphorrhea | 1 | Anemia | 1 | |
Gastric ulcer | 1 | Grade 4 | ||
Grade 3a | Intraoperative massive bleeding | 1 | ||
Lymphorrhea | 1 | |||
Grade 3b | ||||
Rectal injury | 1 | |||
Ureteral injury | 1 | |||
Incidence (all grades) | 11 | 9 | ||
14.20% | 10.10% | |||
Incidence (≥ grade 3) | 3 | 1 | ||
3.90% | 1.10% |
- Citation: Kondo T, Takagi T, Tanabe K. Therapeutic role of template-based lymphadenectomy in urothelial carcinoma of the upper urinary tract. World J Clin Oncol 2015; 6(6): 237-251
- URL: https://www.wjgnet.com/2218-4333/full/v6/i6/237.htm
- DOI: https://dx.doi.org/10.5306/wjco.v6.i6.237