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KMID : 0191120090240040674
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Journal of Korean Medical Science
2009 Volume.24 No. 4 p.674 ~ p.678
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Clinical Significance of Lymph Node Dissection in Patients with Muscle-Invasive Upper Urinary Tract Transitional Cell Carcinoma Treated with Nephroureterectomy
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Cho Kang-Su
Choi Hyun-Min
Koo Kyo-Chul
Park Sung-Jin
Rha Koon-Ho
Choi Young-Deuk
Chung Byung-Ha
Cho Nam-Hoon
Yang Seung-Choul
Hong Sung-Joon
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Abstract
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We investigated the value of lymph node dissection in patients with cN0 muscle-invasive transitional cell carcinoma of the upper urinary tract (UUT-TCC). Medical records of 152 patients with cN0 muscle-invasive UUT-TCC, who underwent nephroureterectomy between 1986 and 2005, were reviewed. Sixty-three patients (41.4%) underwent lymph node dissection. The median number of lymph nodes harvested was 6 (range, 1 to 35), and from these, lymph node involvement was confirmed in 9 patients (14.3%). Locoregional recurrence (LR) and disease-recurrence (DR) occurred in 29 patients and 63 patients, respectively. Fifty-five patients (36.2%) had died of cancer at the last follow-up. The number of lymph nodes harvested was associated with the reduction of LR (χ2trend=6.755, P=0.009), but was not associated with DR (χ2trend=1.558, P=0.212). In the survival analysis, N stage (P=0.0251) and lymph node dissection (P=0.0073) had significant influence on LR, but not on DR or disease-specific survival. However, the number of lymph nodes harvested did not affect LR-free, DR-free, or disease-specific survival. We conclude that lymph node dissection may improve the control of locoregional cancer, as well as staging accuracy, in cN0 muscle-invasive UUT-TCC, but that it does not clearly influence survival.
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KEYWORD
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Carcinoma, Transitional Cell, Ureter, Kidney Pelvis, Recurrence, Lymph Node Excision
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