Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2018 Apr 10;18(1):24.
doi: 10.1186/s12894-018-0336-5.

Role of lymph node dissection in the management of upper tract urothelial carcinomas: a meta-analysis

Runqi Guo  1 , Yuze Zhu  1 , Gengyan Xiong  1 , Xuesong Li  1 , Kai Zhang  2 , Liqun Zhou  3
Affiliations
Meta-Analysis

Role of lymph node dissection in the management of upper tract urothelial carcinomas: a meta-analysis

Runqi Guo et al. BMC Urol. .

Abstract

Background: Lymph node dissection (LND) is not routinely performed during radical nephroureterectomy (RNU) in upper tract urothelial carcinomas (UTUC) and the role of LND has been controversial. We aim to investigate whether patients with LND had improved survival in UTUC patients.

Methods: We performed a systematic literature search of PubMed, Embase, and Cochrane library for citations published prior to January 2016, describing LND performed among UTUC patients and conducted a standard meta-analysis of survival outcomes.

Results: Eleven eligible studies containing 7516 patients satisfied the inclusion criteria. Pooled HRs for cancer-specific survival (CSS) and recurrence-free survival (RFS) were 1.17 (P = 0.18) and 1.33 (P = 0.19) respectively. However, the patients in the LND group had more advanced tumour stages and grades (P < 0.001). Further subgroup analysis showed that among muscle-invasive UTUC patients, the pooled HR for CSS and RFS were 1.10 (P = 0.42) and 0.92 (P = 0.72) respectively. Besides, no difference was found in CSS and RFS between pN0 and pNx individuals in overall populations and in patients with muscle-invasive UTUC, while pN+ patients had significantly worse prognosis when compared to pN0 patients.

Conclusions: LND during RNU allows more accurate staging and prediction of survival, but it remains uncertain whether LND independently improves survival in patients with UTUC. However, standard use of LND should be further investigated in a multi-center, prospective evaluation to obtain a definitive statement regarding this matter.

Keywords: Lymph node dissection; Recurrence; Survival; Upper urinary tract; Urothelial carcinoma.

PubMed Disclaimer

Conflict of interest statement

Competing interest

The authors declare that they have no competing interests.

Consent for publication

Not applicable.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flowchart of study selection
Fig. 2
Fig. 2
Forest plot comparing survival and subgroup analysis of different pT statuses. (A1) CSS in patients receiving LND versus NLND; (A2) CSS in patients considered pN0/pNx; (A3) CSS in patients considered pN+/pN0; (B1) RFS in patients receiving LND versus NLND; (B2) RFS in patients considered pN0/pNx; (B3) RFS in patients considered pN+/pN0; (C1) CSS in muscle-invasive UTUC patients receiving LND versus NLND; (C2) RFS in muscle-invasive UTUC patients receiving LND versus NLND; (C3) CSS in patients of muscle-invasive UTUC considered pN0/pNx; (C4) RFS survival in patients of muscle-invasive UTUC considered pN0/pNx; (C5) CSS in patients of muscle-invasive UTUC considered pN+/pN0; (C6) RFS survival in patients of muscle-invasive UTUC considered pN+/pN0. CSS, cancer-specific surviva; LND: lymph node dissection; NLND: non-lymph node dissection; pN0: Negative lymph node; pNx: Not undergo lymph node dissection; RFS, recurrence-free survival; UTUC: upper tract urothelial carcinoma.
Fig. 3
Fig. 3
Funnel plot for the evaluation of potential publication bias. (a) cancer-specific survival; (b) recurrence-free survival
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Oxford Centre for Evidence-based Medicine Levels of Evidence (May 2009). Produced by bob Phillips, Chris ball, Dave Sackett, Doug Badenoch, Sharon Straus, Brian Haynes, Martin Dawes since November 1998. Updated by Jeremy Howick March 2009.
    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65:5–29. doi: 10.3322/caac.21254. - DOI - PubMed
    1. Rouprêt M, Babjuk M, Compérat E, Zigeuner R, Sylvester RJ, Burger M, et al. European Association of Urology guidelines on upper urinary tract urothelial cell carcinoma: 2015 update. Eur Urol. 2015;68:868–879. doi: 10.1016/j.eururo.2015.06.044. - DOI - PubMed
    1. Corrado F, Ferri C, Mannini D, Corrado G, Bertoni F, Bacchini P, et al. Transitional cell carcinoma of the upper urinary tract: evaluation of prognostic factors by histopathology and flow cytometric analysis. J Urol. 1991;145:1159–1163. doi: 10.1016/S0022-5347(17)38562-2. - DOI - PubMed
    1. Schatteman P, Chatzopoulos C, Assenmacher C, De Visscher L, Jorion JL, Blaze V, et al. Laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma: results of a Belgian retrospective multicentre survey. Eur Urol. 2007;51:1633–1638. doi: 10.1016/j.eururo.2006.09.016. - DOI - PubMed

Publication types

LinkOut - more resources