AUTHOR=Xia Hao-ran , Li Shu-guang , Zhai Xing-quan , Liu Min , Guo Xiao-xiao , Wang Jian-ye 

TITLE=The Value of Lymph Node Dissection in Patients With Node-Positive Upper Urinary Tract Urothelial Cancer: A Retrospective Cohort Study

JOURNAL=Frontiers in Oncology

VOLUME=Volume 12 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.889144

DOI=10.3389/fonc.2022.889144

ISSN=2234-943X

ABSTRACT=Purpose: The value of lymphadenectomy during radical nephroureterectomy (RNU) remains unclear. This study aimed to determine the effects of the removed lymph nodes (RLNs) counts, positive lymph nodes (pLNs) counts, and pLN density (pLND) on survival outcomes in patients with node-positive upper urinary tract urothelial cancer (UTUC).
Methods: A total of 306 patients with node-positive UTUC in the Surveillance, Epidemiology, and End Results database between 2004 and 2016 were identified. Multivariable Cox regression analyses were used to evaluate the effect of RLNs counts, pLNs counts, and pLND on survival outcomes. The maximally selected rank statistic was used to determine the most informative cut-off value for pLND on survival outcomes. 
Results: The RLNs counts or pLNs counts were not associated with survival outcomes, whereas higher pLND was associated with lower cancer-specific survival (CSS) and overall survival (OS) (hazard ratio [HR] 1.75; p = 0.014 and HR 1.62; p = 0.036, respectively). The most informative cut-off value for pLND in relation to survival was 27%. Patients with pLND ≥27% had worse 5-years survival rates than those with pLND < 27% (52.9% versus 75.9% for CSS and 18.7% versus 34.2% for OS, each P <0.05). Furthermore, the multivariable Cox regression model included pLND could predict 5-year CSS (AUC 0.732 vs. 0.647) or OS (AUC 0.704 vs. 0.621) more accurately than the model without pLND.
Conclusions: For patients with node-positive UTUC, more lymph nodes removed does not offer a better therapeutic effect. However, pLND provides additional prognostic value.