Potential Benefit of Lymph Node Dissection During Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma

A Systematic Review by the European Association of Urology Guidelines Panel on Non-muscle-invasive Bladder Cancer

Jose Luis Dominguez-Escrig (Corresponding Author), Benoit Peyronnet, Thomas Seisen, Harman M Bruins, Cathy Yuhong Yuan, Marko Babjuk, Andreas Böhle, Maximilian Burger, Eva M Compérat, Paolo Gontero, Thomas Lam, Steven MacLennan, Hugh Mostafid, Joan Palou, Bas W G van Rhijn, Richard J Sylvester, Richard Zigeuner, Shahrokh F Shariat, Morgan Rouprêt

Research output: Contribution to journalReview article

6 Citations (Scopus)

Abstract

CONTEXT: The oncological efficacy of routine lymphadenectomy (lymph node dissection [LND]) at the time of radical nephroureterectomy (RNU) remains controversial.

OBJECTIVE: To systematically review the available literature assessing the impact of LND in upper tract urothelial carcinoma (UTUC) patients.

EVIDENCE ACQUISITION: Embase, Medline, and Cochrane databases were searched for all studies comparing outcomes of patients undergoing RNU without LND versus any form of LND. We identified nine retrospective studies eligible for inclusion in this systematic review. We took cancer-specific survival (CSS) as the primary end point, and performed a narrative review and risk of bias assessment.

EVIDENCE SYNTHESIS: Six studies compared outcomes of no LND versus LND. Three studies compared complete LND versus incomplete LND versus no LND. The incidence of pN+ in patients with high-stage (≥pT2) tumours ranged from 14.3% to 40%. Pre- and postoperative characteristics differed among the study groups, potentially biasing the results, as demonstrated by the risk of bias assessment, potentially favouring the LND group. Oncological outcomes such as cancer-specific, overall, recurrence-free, and metastasis-free survival were reviewed, demonstrating a survival benefit with LND in high-stage disease of the renal pelvis.

CONCLUSIONS: Template-based and complete LND improves CSS in patients with high-stage (≥pT2) UTUC and reduces the risk of local recurrence. The impact of LND in ureteral tumours remains uncertain.

PATIENT SUMMARY: Studies comparing radical nephroureterectomy with or without the removal of nodes (lymph node dissection [LND]) were analysed. LND improves survival in patients with high-stage disease of the renal pelvis, if it is performed according to an anatomical template-based approach.

Original languageEnglish
Pages (from-to)224-241
Number of pages18
JournalEuropean Urology Focus
Volume5
Issue number2
Early online date20 Nov 2017
DOIs
Publication statusPublished - Mar 2019

Fingerprint

Lymph Node Excision
Urinary Bladder Neoplasms
Guidelines
Carcinoma
Survival
Kidney Pelvis
Neoplasms
Outcome Assessment (Health Care)
Recurrence

Keywords

  • Journal Article
  • Recurrence
  • Urothelial carcinoma
  • Renal pelvis
  • Ureter
  • Survival Nodes
  • Metastasis
  • Survival
  • Nodes
  • SURVIVAL
  • METAANALYSIS
  • UPPER URINARY-TRACT
  • CLINICAL-TRIAL
  • IMPACT
  • NEOADJUVANT CHEMOTHERAPY
  • TRANSITIONAL-CELL CARCINOMA
  • TEMPLATE-BASED LYMPHADENECTOMY
  • CYSTECTOMY
  • ONCOLOGICAL OUTCOMES

ASJC Scopus subject areas

  • Urology

Cite this

Potential Benefit of Lymph Node Dissection During Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma : A Systematic Review by the European Association of Urology Guidelines Panel on Non-muscle-invasive Bladder Cancer. / Dominguez-Escrig, Jose Luis (Corresponding Author); Peyronnet, Benoit; Seisen, Thomas; Bruins, Harman M; Yuan, Cathy Yuhong; Babjuk, Marko; Böhle, Andreas; Burger, Maximilian; Compérat, Eva M; Gontero, Paolo; Lam, Thomas; MacLennan, Steven; Mostafid, Hugh; Palou, Joan; van Rhijn, Bas W G; Sylvester, Richard J; Zigeuner, Richard; Shariat, Shahrokh F; Rouprêt, Morgan.

In: European Urology Focus, Vol. 5, No. 2, 03.2019, p. 224-241.

Research output: Contribution to journalReview article

Dominguez-Escrig, JL, Peyronnet, B, Seisen, T, Bruins, HM, Yuan, CY, Babjuk, M, Böhle, A, Burger, M, Compérat, EM, Gontero, P, Lam, T, MacLennan, S, Mostafid, H, Palou, J, van Rhijn, BWG, Sylvester, RJ, Zigeuner, R, Shariat, SF & Rouprêt, M 2019, 'Potential Benefit of Lymph Node Dissection During Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Systematic Review by the European Association of Urology Guidelines Panel on Non-muscle-invasive Bladder Cancer', European Urology Focus, vol. 5, no. 2, pp. 224-241. https://doi.org/10.1016/j.euf.2017.09.015
Dominguez-Escrig, Jose Luis ; Peyronnet, Benoit ; Seisen, Thomas ; Bruins, Harman M ; Yuan, Cathy Yuhong ; Babjuk, Marko ; Böhle, Andreas ; Burger, Maximilian ; Compérat, Eva M ; Gontero, Paolo ; Lam, Thomas ; MacLennan, Steven ; Mostafid, Hugh ; Palou, Joan ; van Rhijn, Bas W G ; Sylvester, Richard J ; Zigeuner, Richard ; Shariat, Shahrokh F ; Rouprêt, Morgan. / Potential Benefit of Lymph Node Dissection During Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma : A Systematic Review by the European Association of Urology Guidelines Panel on Non-muscle-invasive Bladder Cancer. In: European Urology Focus. 2019 ; Vol. 5, No. 2. pp. 224-241.
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title = "Potential Benefit of Lymph Node Dissection During Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Systematic Review by the European Association of Urology Guidelines Panel on Non-muscle-invasive Bladder Cancer",
abstract = "CONTEXT: The oncological efficacy of routine lymphadenectomy (lymph node dissection [LND]) at the time of radical nephroureterectomy (RNU) remains controversial.OBJECTIVE: To systematically review the available literature assessing the impact of LND in upper tract urothelial carcinoma (UTUC) patients.EVIDENCE ACQUISITION: Embase, Medline, and Cochrane databases were searched for all studies comparing outcomes of patients undergoing RNU without LND versus any form of LND. We identified nine retrospective studies eligible for inclusion in this systematic review. We took cancer-specific survival (CSS) as the primary end point, and performed a narrative review and risk of bias assessment.EVIDENCE SYNTHESIS: Six studies compared outcomes of no LND versus LND. Three studies compared complete LND versus incomplete LND versus no LND. The incidence of pN+ in patients with high-stage (≥pT2) tumours ranged from 14.3{\%} to 40{\%}. Pre- and postoperative characteristics differed among the study groups, potentially biasing the results, as demonstrated by the risk of bias assessment, potentially favouring the LND group. Oncological outcomes such as cancer-specific, overall, recurrence-free, and metastasis-free survival were reviewed, demonstrating a survival benefit with LND in high-stage disease of the renal pelvis.CONCLUSIONS: Template-based and complete LND improves CSS in patients with high-stage (≥pT2) UTUC and reduces the risk of local recurrence. The impact of LND in ureteral tumours remains uncertain.PATIENT SUMMARY: Studies comparing radical nephroureterectomy with or without the removal of nodes (lymph node dissection [LND]) were analysed. LND improves survival in patients with high-stage disease of the renal pelvis, if it is performed according to an anatomical template-based approach.",
keywords = "Journal Article, Recurrence, Urothelial carcinoma, Renal pelvis, Ureter, Survival Nodes, Metastasis, Survival, Nodes, SURVIVAL, METAANALYSIS, UPPER URINARY-TRACT, CLINICAL-TRIAL, IMPACT, NEOADJUVANT CHEMOTHERAPY, TRANSITIONAL-CELL CARCINOMA, TEMPLATE-BASED LYMPHADENECTOMY, CYSTECTOMY, ONCOLOGICAL OUTCOMES",
author = "Dominguez-Escrig, {Jose Luis} and Benoit Peyronnet and Thomas Seisen and Bruins, {Harman M} and Yuan, {Cathy Yuhong} and Marko Babjuk and Andreas B{\"o}hle and Maximilian Burger and Comp{\'e}rat, {Eva M} and Paolo Gontero and Thomas Lam and Steven MacLennan and Hugh Mostafid and Joan Palou and {van Rhijn}, {Bas W G} and Sylvester, {Richard J} and Richard Zigeuner and Shariat, {Shahrokh F} and Morgan Roupr{\^e}t",
note = "Copyright {\circledC} 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.",
year = "2019",
month = "3",
doi = "10.1016/j.euf.2017.09.015",
language = "English",
volume = "5",
pages = "224--241",
journal = "European Urology Focus",
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TY - JOUR

T1 - Potential Benefit of Lymph Node Dissection During Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma

T2 - A Systematic Review by the European Association of Urology Guidelines Panel on Non-muscle-invasive Bladder Cancer

AU - Dominguez-Escrig, Jose Luis

AU - Peyronnet, Benoit

AU - Seisen, Thomas

AU - Bruins, Harman M

AU - Yuan, Cathy Yuhong

AU - Babjuk, Marko

AU - Böhle, Andreas

AU - Burger, Maximilian

AU - Compérat, Eva M

AU - Gontero, Paolo

AU - Lam, Thomas

AU - MacLennan, Steven

AU - Mostafid, Hugh

AU - Palou, Joan

AU - van Rhijn, Bas W G

AU - Sylvester, Richard J

AU - Zigeuner, Richard

AU - Shariat, Shahrokh F

AU - Rouprêt, Morgan

N1 - Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

PY - 2019/3

Y1 - 2019/3

N2 - CONTEXT: The oncological efficacy of routine lymphadenectomy (lymph node dissection [LND]) at the time of radical nephroureterectomy (RNU) remains controversial.OBJECTIVE: To systematically review the available literature assessing the impact of LND in upper tract urothelial carcinoma (UTUC) patients.EVIDENCE ACQUISITION: Embase, Medline, and Cochrane databases were searched for all studies comparing outcomes of patients undergoing RNU without LND versus any form of LND. We identified nine retrospective studies eligible for inclusion in this systematic review. We took cancer-specific survival (CSS) as the primary end point, and performed a narrative review and risk of bias assessment.EVIDENCE SYNTHESIS: Six studies compared outcomes of no LND versus LND. Three studies compared complete LND versus incomplete LND versus no LND. The incidence of pN+ in patients with high-stage (≥pT2) tumours ranged from 14.3% to 40%. Pre- and postoperative characteristics differed among the study groups, potentially biasing the results, as demonstrated by the risk of bias assessment, potentially favouring the LND group. Oncological outcomes such as cancer-specific, overall, recurrence-free, and metastasis-free survival were reviewed, demonstrating a survival benefit with LND in high-stage disease of the renal pelvis.CONCLUSIONS: Template-based and complete LND improves CSS in patients with high-stage (≥pT2) UTUC and reduces the risk of local recurrence. The impact of LND in ureteral tumours remains uncertain.PATIENT SUMMARY: Studies comparing radical nephroureterectomy with or without the removal of nodes (lymph node dissection [LND]) were analysed. LND improves survival in patients with high-stage disease of the renal pelvis, if it is performed according to an anatomical template-based approach.

AB - CONTEXT: The oncological efficacy of routine lymphadenectomy (lymph node dissection [LND]) at the time of radical nephroureterectomy (RNU) remains controversial.OBJECTIVE: To systematically review the available literature assessing the impact of LND in upper tract urothelial carcinoma (UTUC) patients.EVIDENCE ACQUISITION: Embase, Medline, and Cochrane databases were searched for all studies comparing outcomes of patients undergoing RNU without LND versus any form of LND. We identified nine retrospective studies eligible for inclusion in this systematic review. We took cancer-specific survival (CSS) as the primary end point, and performed a narrative review and risk of bias assessment.EVIDENCE SYNTHESIS: Six studies compared outcomes of no LND versus LND. Three studies compared complete LND versus incomplete LND versus no LND. The incidence of pN+ in patients with high-stage (≥pT2) tumours ranged from 14.3% to 40%. Pre- and postoperative characteristics differed among the study groups, potentially biasing the results, as demonstrated by the risk of bias assessment, potentially favouring the LND group. Oncological outcomes such as cancer-specific, overall, recurrence-free, and metastasis-free survival were reviewed, demonstrating a survival benefit with LND in high-stage disease of the renal pelvis.CONCLUSIONS: Template-based and complete LND improves CSS in patients with high-stage (≥pT2) UTUC and reduces the risk of local recurrence. The impact of LND in ureteral tumours remains uncertain.PATIENT SUMMARY: Studies comparing radical nephroureterectomy with or without the removal of nodes (lymph node dissection [LND]) were analysed. LND improves survival in patients with high-stage disease of the renal pelvis, if it is performed according to an anatomical template-based approach.

KW - Journal Article

KW - Recurrence

KW - Urothelial carcinoma

KW - Renal pelvis

KW - Ureter

KW - Survival Nodes

KW - Metastasis

KW - Survival

KW - Nodes

KW - SURVIVAL

KW - METAANALYSIS

KW - UPPER URINARY-TRACT

KW - CLINICAL-TRIAL

KW - IMPACT

KW - NEOADJUVANT CHEMOTHERAPY

KW - TRANSITIONAL-CELL CARCINOMA

KW - TEMPLATE-BASED LYMPHADENECTOMY

KW - CYSTECTOMY

KW - ONCOLOGICAL OUTCOMES

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U2 - 10.1016/j.euf.2017.09.015

DO - 10.1016/j.euf.2017.09.015

M3 - Review article

VL - 5

SP - 224

EP - 241

JO - European Urology Focus

JF - European Urology Focus

SN - 2405-4569

IS - 2

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