Prediction of true nodal status in patients with pathological lymph node negative upper tract urothelial carcinoma at radical nephroureterectomy.
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Prediction of true nodal status in patients with pathological lymph node negative upper tract urothelial carcinoma at radical nephroureterectomy. / Xylinas, Evanguelos; Rink, Michael; Margulis, Vitaly; Faison, Talia; Comploj, Evi; Novara, Giacomo; Raman, Jay D; Lotan, Yair; Guillonneau, Bertrand; Weizer, Alon; Pycha, Armin; Scherr, Douglas S; Seitz, Christian; Sun, Maxine; Trinh, Quoc-Dien; Karakiewicz, Pierre I; Montorsi, Francesco; Zerbib, Marc; Gönen, Mithat; Shariat, Shahrokh F; UTUC Collaboration.
in: J UROLOGY, Jahrgang 189, Nr. 2, 2, 2013, S. 468-473.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Prediction of true nodal status in patients with pathological lymph node negative upper tract urothelial carcinoma at radical nephroureterectomy.
AU - Xylinas, Evanguelos
AU - Rink, Michael
AU - Margulis, Vitaly
AU - Faison, Talia
AU - Comploj, Evi
AU - Novara, Giacomo
AU - Raman, Jay D
AU - Lotan, Yair
AU - Guillonneau, Bertrand
AU - Weizer, Alon
AU - Pycha, Armin
AU - Scherr, Douglas S
AU - Seitz, Christian
AU - Sun, Maxine
AU - Trinh, Quoc-Dien
AU - Karakiewicz, Pierre I
AU - Montorsi, Francesco
AU - Zerbib, Marc
AU - Gönen, Mithat
AU - Shariat, Shahrokh F
AU - UTUC Collaboration
N1 - Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
PY - 2013
Y1 - 2013
N2 - PURPOSE: The role of lymph node dissection is still controversial in patients treated with radical nephroureterectomy for upper tract urothelial cancer. We developed a pathological nodal staging model that allows quantification of the likelihood that a patient with pathologically node negative disease has, indeed, no lymph node metastasis.MATERIALS AND METHODS: We analyzed data on 814 patients treated with radical nephroureterectomy and lymph node dissection, and estimated the sensitivity of pathological nodal staging using a β-binomial model. We developed a pathological nodal staging score that represents the probability that a case is correctly staged as node negative.RESULTS: A median of 5 lymph nodes (range 1 to 46) was removed and 593 patients (73%) had pN0 disease. The probability of missing lymph node metastasis decreased as the number of nodes examined increased. If only a single node was examined, 44% of patients would have been misclassified as having pN0 disease while harboring lymph node metastasis. Even when 5 nodes were examined, 12% of patients would have been misclassified. The proportion of those with a positive node increased with advancing pathological T stage and lymphovascular invasion. Patients with pT0-Ta-Tis-T1/lymphovascular invasion had more than a 95% chance of correct pathological nodal staging with 2 examined nodes. However, if a patient had pT3-T4 and positive lymphovascular invasion, even 20 examined lymph nodes did not attain 95% accuracy.CONCLUSIONS: Lymph node dissection provides more accurate staging and prediction of survival. The number of examined nodes needed for adequate staging depends on pT stage and lymphovascular invasion. We developed a tool to estimate the likelihood of false-negative lymph node metastasis, which could help refine clinical decision making regarding the administration of adjuvant chemotherapy.
AB - PURPOSE: The role of lymph node dissection is still controversial in patients treated with radical nephroureterectomy for upper tract urothelial cancer. We developed a pathological nodal staging model that allows quantification of the likelihood that a patient with pathologically node negative disease has, indeed, no lymph node metastasis.MATERIALS AND METHODS: We analyzed data on 814 patients treated with radical nephroureterectomy and lymph node dissection, and estimated the sensitivity of pathological nodal staging using a β-binomial model. We developed a pathological nodal staging score that represents the probability that a case is correctly staged as node negative.RESULTS: A median of 5 lymph nodes (range 1 to 46) was removed and 593 patients (73%) had pN0 disease. The probability of missing lymph node metastasis decreased as the number of nodes examined increased. If only a single node was examined, 44% of patients would have been misclassified as having pN0 disease while harboring lymph node metastasis. Even when 5 nodes were examined, 12% of patients would have been misclassified. The proportion of those with a positive node increased with advancing pathological T stage and lymphovascular invasion. Patients with pT0-Ta-Tis-T1/lymphovascular invasion had more than a 95% chance of correct pathological nodal staging with 2 examined nodes. However, if a patient had pT3-T4 and positive lymphovascular invasion, even 20 examined lymph nodes did not attain 95% accuracy.CONCLUSIONS: Lymph node dissection provides more accurate staging and prediction of survival. The number of examined nodes needed for adequate staging depends on pT stage and lymphovascular invasion. We developed a tool to estimate the likelihood of false-negative lymph node metastasis, which could help refine clinical decision making regarding the administration of adjuvant chemotherapy.
KW - Adult
KW - Humans
KW - Male
KW - Aged
KW - Female
KW - Middle Aged
KW - Aged, 80 and over
KW - Prognosis
KW - Retrospective Studies
KW - Ureter/surgery
KW - Lymphatic Metastasis/pathology
KW - Nephrectomy/methods
KW - Carcinoma, Transitional Cell/pathology/surgery
KW - Kidney Neoplasms/pathology/surgery
KW - Ureteral Neoplasms/pathology/surgery
KW - Adult
KW - Humans
KW - Male
KW - Aged
KW - Female
KW - Middle Aged
KW - Aged, 80 and over
KW - Prognosis
KW - Retrospective Studies
KW - Ureter/surgery
KW - Lymphatic Metastasis/pathology
KW - Nephrectomy/methods
KW - Carcinoma, Transitional Cell/pathology/surgery
KW - Kidney Neoplasms/pathology/surgery
KW - Ureteral Neoplasms/pathology/surgery
U2 - 10.1016/j.juro.2012.09.036
DO - 10.1016/j.juro.2012.09.036
M3 - SCORING: Journal article
C2 - 23253960
VL - 189
SP - 468
EP - 473
JO - J UROLOGY
JF - J UROLOGY
SN - 0022-5347
IS - 2
M1 - 2
ER -