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.
Adult
Aged
Aged, 80 and over
Bias
Carcinoma, Transitional Cell
/ pathology
Disease-Free Survival
Europe
/ epidemiology
Female
Humans
Kidney Pelvis
/ pathology
Lymph Node Excision
/ adverse effects
Lymph Nodes
/ pathology
Male
Middle Aged
Neoplasm Staging
Nephroureterectomy
/ methods
Retrospective Studies
Ureteral Neoplasms
/ pathology
Urinary Bladder Neoplasms
/ pathology
Urology
/ organization & administration
Metastasis
Nodes
Recurrence
Renal pelvis
Survival
Ureter
Urothelial carcinoma
Journal
European urology focus
ISSN: 2405-4569
Titre abrégé: Eur Urol Focus
Pays: Netherlands
ID NLM: 101665661
Informations de publication
Date de publication:
03 2019
03 2019
Historique:
received:
25
04
2017
revised:
15
08
2017
accepted:
21
09
2017
pubmed:
22
11
2017
medline:
18
12
2019
entrez:
22
11
2017
Statut:
ppublish
Résumé
The oncological efficacy of routine lymphadenectomy (lymph node dissection [LND]) at the time of radical nephroureterectomy (RNU) remains controversial. To systematically review the available literature assessing the impact of LND in upper tract urothelial carcinoma (UTUC) patients. 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. 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. 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. 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.
Identifiants
pubmed: 29158169
pii: S2405-4569(17)30236-5
doi: 10.1016/j.euf.2017.09.015
pii:
doi:
Types de publication
Comparative Study
Journal Article
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
224-241Informations de copyright
Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.