淋巴結廓清於接受根治性腎切除術之無臨床淋巴轉移尿路上皮癌病患的角色

邱泰樺¹、李香瑩^1,2、李經家^1,2、葉信志^1,2

¹高雄醫學大學附設中和紀念醫院泌尿部；²高雄市立大同醫院 泌尿科

The Role of Lymph Node Dissection in Patients with Upper Tract Urothelial Carcinoma without Clinical Lymph Node Metastasis Undergoing Radical Nephroureterectomy

Tai-Hua Chiu¹, Hsiang ying Lee^1,2, Ching-Chia Li^1,2, Hsin-Chih Yeh^1,2

¹Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

²Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan

Purpose: Upper tract urothelial carcinoma (UTUC) has a higher incidence in Taiwan than in other countries. Radical nephroureterectomy (NU) with bladder cuff excision is the standard treatment for non-metastatic UTUC, but the role of routine concomitant lymph node dissection (LND) in UTUC is still controversial. We aimed to discuss the issue of whether LND is necessary for UTUC patients without clinical lymph node metastasis (cN0) before radical surgery.

Materials and Methods: We identified a total of 2726 UTUC patients from the updated data of the Taiwan UTUC Collaboration Group. 658 patients with ≥ pT2 stage was enrolled finally. We used Kaplan–Meier estimator and Cox proportional hazards model to analyze overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and bladder recurrence-free survival (BRFS) in groups with and without LND.

Results: Among 658 patients included, 195 patients received LND and 463 patients received nephroureterectomy without LND. No significant difference in survival rate between LND (+) and LND (-) group was found in both univariate and multivariate survival analysis. In LND (+) group, 18.5% patients have pathological lymph node metastasis. Compared with pN0 patients, worse CSS (p = 0.010) and DFS (p < 0.001) was found in pN+ subgroup.

Conclusions: In the present study, no significant survival benefit related to LND in cN0 stage, ≥ pT2 stage UTUC was found, irrespective of the number of LNs removed, although pN+ affected cancer prognosis. Moreover, from the data of pN (+) subgroup of LND (+) cohort analysis, due to low positive predictive value of pN (+), NU without LND may be acceptable in patients with cT2N0 stage.