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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, Vol. 189, No. 2, 2, 2013, p. 468-473.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Xylinas, E, Rink, M, Margulis, V, Faison, T, Comploj, E, Novara, G, Raman, JD, Lotan, Y, Guillonneau, B, Weizer, A, Pycha, A, Scherr, DS, Seitz, C, Sun, M, Trinh, Q-D, Karakiewicz, PI, Montorsi, F, Zerbib, M, Gönen, M, Shariat, SF & UTUC Collaboration 2013, 'Prediction of true nodal status in patients with pathological lymph node negative upper tract urothelial carcinoma at radical nephroureterectomy.', J UROLOGY, vol. 189, no. 2, 2, pp. 468-473. https://doi.org/10.1016/j.juro.2012.09.036

APA

Xylinas, E., Rink, M., Margulis, V., Faison, T., Comploj, E., Novara, G., Raman, J. D., Lotan, Y., Guillonneau, B., Weizer, A., Pycha, A., Scherr, D. S., Seitz, C., Sun, M., Trinh, Q-D., Karakiewicz, P. I., Montorsi, F., Zerbib, M., Gönen, M., ... UTUC Collaboration (2013). Prediction of true nodal status in patients with pathological lymph node negative upper tract urothelial carcinoma at radical nephroureterectomy. J UROLOGY, 189(2), 468-473. [2]. https://doi.org/10.1016/j.juro.2012.09.036

Vancouver

Xylinas E, Rink M, Margulis V, Faison T, Comploj E, Novara G et al. Prediction of true nodal status in patients with pathological lymph node negative upper tract urothelial carcinoma at radical nephroureterectomy. J UROLOGY. 2013;189(2):468-473. 2. https://doi.org/10.1016/j.juro.2012.09.036

Bibtex

@article{3455e3d8c0844ff88350c05716823b8b,
title = "Prediction of true nodal status in patients with pathological lymph node negative upper tract urothelial carcinoma at radical nephroureterectomy.",
abstract = "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.",
keywords = "Adult, Humans, Male, Aged, Female, Middle Aged, Aged, 80 and over, Prognosis, Retrospective Studies, Ureter/*surgery, Lymphatic Metastasis/pathology, *Nephrectomy/methods, Carcinoma, Transitional Cell/*pathology/*surgery, Kidney Neoplasms/*pathology/*surgery, Ureteral Neoplasms/*pathology/*surgery, Adult, Humans, Male, Aged, Female, Middle Aged, Aged, 80 and over, Prognosis, Retrospective Studies, Ureter/*surgery, Lymphatic Metastasis/pathology, *Nephrectomy/methods, Carcinoma, Transitional Cell/*pathology/*surgery, Kidney Neoplasms/*pathology/*surgery, Ureteral Neoplasms/*pathology/*surgery",
author = "Evanguelos Xylinas and Michael Rink and Vitaly Margulis and Talia Faison and Evi Comploj and Giacomo Novara and Raman, {Jay D} and Yair Lotan and Bertrand Guillonneau and Alon Weizer and Armin Pycha and Scherr, {Douglas S} and Christian Seitz and Maxine Sun and Quoc-Dien Trinh and Karakiewicz, {Pierre I} and Francesco Montorsi and Marc Zerbib and Mithat G{\"o}nen and Shariat, {Shahrokh F} and {UTUC Collaboration}",
note = "Copyright {\textcopyright} 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.",
year = "2013",
doi = "10.1016/j.juro.2012.09.036",
language = "English",
volume = "189",
pages = "468--473",
journal = "J UROLOGY",
issn = "0022-5347",
publisher = "Elsevier Inc.",
number = "2",

}

RIS

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 -