1.Clinical Significance of Lymph Node Dissection in Patients with Muscle-Invasive Upper Urinary Tract Transitional Cell Carcinoma Treated with Nephroureterectomy.
Kang Su CHO ; Hyun Min CHOI ; Kyochul KOO ; Sung Jin PARK ; Koon Ho RHA ; Young Deuk CHOI ; Byung Ha CHUNG ; Nam Hoon CHO ; Seung Choul YANG ; Sung Joon HONG
Journal of Korean Medical Science 2009;24(4):674-678
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 (chi-square(trend)=6.755, P=0.009), but was not associated with DR (chi-square(trend)=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.
Aged
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Aged, 80 and over
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Carcinoma, Transitional Cell/mortality/*surgery/therapy
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Female
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Humans
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Kidney Neoplasms/mortality/*surgery/therapy
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*Lymph Node Excision
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Male
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Middle Aged
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Neoplasm Staging
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Nephrectomy
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Recurrence
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Retrospective Studies
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Survival Analysis
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Ureteral Neoplasms/mortality/*surgery/therapy