Presentation Authors: Michael Daneshvar*, Michael Daugherty, Oleg Shapiro, Syracuse, NY
Introduction: Upper tract urothelial carcinoma (UTUC) is a rare condition and the gold standard for treatment is nephroureterectomy. However, the role for lymph node dissection (LND) has not been clearly defined in the management of this disease. LND is beneficial for complete oncologic staging and may play a role in improving survival in several malignancies. We hypothesize that nephroureterectomy with LND will improve survival in patients with UTUC.
Methods: SEER-18 registries database was queried for patients surgically treated for upper tract UC from the years 2004-2013. Patients were excluded that had node positive disease. Patients were separated in to two cohorts, those patients without LND (Nx) and those that had LND (N0) performed. LND was defined as â‰¥1 lymph node removed for pathologic analysis. There were 6,758 and 1,655 patients in the Nx and N0 cohorts, respectively. Overall survival (OS) was compared between the groups using logRank analysis and then using cox-proportional hazards model while adjusting for age, race, gender, and T stage.
Results: There were significant differences seen in patient age, race and T stage between groups. There was no difference in gender distribution. The mean follow-up of patients was 37.4 months. There was a difference in overall survival between groups (p=0.04). When adjusting for patient age, race and T-stage, LND showed a benefit in OS (HR 0.89, p=0.009).
Conclusions: Present SEER analysis shows an improvement in overall survival for patients with UTUC undergoing LND at time of definitive surgery without node positive disease. Possibly the LND removes micrometastatic disease not visible on pathologic assessment and is the reason for improved survival. This ultimately warrants further evaluation.