Role of lymph node dissection during radical nephroureterectomy for upper urinary tract urothelial cancer: multi-institutional large retrospective study JCOG1110A

World J Urol. 2017 Nov;35(11):1737-1744. doi: 10.1007/s00345-017-2049-x. Epub 2017 May 15.


Purpose: To evaluate the impact of lymph node dissection (LND) on clinical outcome during radical nephroureterectomy (RNU) for patients with upper urinary tract urothelial cancer (UTUC).

Methods: We, the Urologic Oncology Study Group of the Japan Clinical Oncology Group (JCOG), retrospectively collected data from patients with non-metastatic UTUC who underwent RNU in 30 centers in 1995-2009. Ineligible patients and patients with previous and/or synchronous bladder cancer were excluded, and the remaining 2037 patients were analyzed. We compared overall and cancer-specific mortality between patients who underwent LND (LND group) and those without LND (no-LND group).

Results: Among 2037 patients, LND was performed in 1046 (51.4%) patients, and 223 (10.9%) patients had pathological node-positive (pN+) disease. All-cause mortality was observed in 503 patients (24.7%) during follow-up (median 45.8 months), including 363 patients (17.8%) who died of UTUC. Patients with pN+ disease showed significantly shorter overall survival (OS) compared with pN0 patients, and the estimated 5-year OS for pN+ patients was 30%. Older age, ≥cT3, and clinical node-positive disease were found as preoperative predictors for pN+ disease by multivariate analysis. In the comparison of OS and cancer-specific mortality between LND and no-LND groups, there was no significant improvement by LND in multivariate analysis. The median number of lymph nodes removed was six (IQR 3-11). There was no significant association between the number of lymph nodes removed and OS.

Conclusions: The present study indicates that there is no therapeutic benefit of LND during RNU for UTUC, although pathologically positive LN status can predict poor prognosis.

Keywords: Japanese; Lymph node dissection; Prognosis; Radical nephroureterectomy; Survival; Upper urinary tract urothelial cancer.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Carcinoma, Transitional Cell / mortality
  • Carcinoma, Transitional Cell / pathology
  • Carcinoma, Transitional Cell / surgery*
  • Cause of Death
  • Female
  • Humans
  • Japan
  • Kidney Neoplasms / mortality
  • Kidney Neoplasms / pathology
  • Kidney Neoplasms / surgery*
  • Kidney Pelvis / pathology
  • Lymph Node Excision / statistics & numerical data*
  • Lymph Nodes / pathology*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Neoplasm Staging
  • Nephroureterectomy / methods*
  • Prognosis
  • Retrospective Studies
  • Survival Rate
  • Ureteral Neoplasms / mortality
  • Ureteral Neoplasms / pathology
  • Ureteral Neoplasms / surgery*