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. 2023 Nov;49(6):345-359.
doi: 10.5152/tud.2023.23045.

The Role of Lymph Node Dissection in the Management of Upper Urothelial Cancer: A Nodal Status-Based Meta-Analytical Study

Abdalla Ali Deb  1 , Ayman Agag  2 , Naufal Naushad  3 , Alice Hartley  4 , Hosam Serag  5
Affiliations

The Role of Lymph Node Dissection in the Management of Upper Urothelial Cancer: A Nodal Status-Based Meta-Analytical Study

Abdalla Ali Deb et al. Urol Res Pract. 2023 Nov.

Abstract

This systematic review was performed to study the prognostic value of lymph node dissection (LND) during nephroureterectomy in upper tract urothelial cancer (UTUC). Five databases were searched on September 11, 2022, to include studies that compared whether LND was performed, the extent of dissection (complete vs. incomplete), and the nodal status (positive "pN+" vs. negative "pN0"). Outcomes included prognosis (overall survival "OS," cancer-specific survival "CSS," disease-free survival "DFS," and recurrence-free survival "RFS") and complications. High-grade complications (≥ grade 3 according to the Clavien-Dindo classification). Data analysis were conducted through STATA. The pooled data are reported log odds ratio (logOR) with 95% CI. Thirty-three studies were analyzed. The LND resulted in improved 5-year OS [logOR=0.10; 95% CI: 0.06-0.15], 5-year CSS [logOR=0.10; 95% CI: 0.04- 0.17], and 10-year CSS [logOR=0.14; 95% CI: 0.06-0.21] when compared to non-LND. However, LND was associated with greater risk of high-grade complications [logOR=0.62; 95% CI: 0.26-0.98]. Complete LND was associated with lower risk of cancer-specific mortality than incomplete LND [logOR=-0.69; 95% CI: -1.22--0.16]. The pN0 patients had better 5-year OS; however, pN+ patients had better prognosis in DFS, RFS (at 2 and 5 years), and CSS (at 2, 5, and 10 years). Lymph node dissection provides a protective role in terms of 5-year OS and 5-year and 10-year CSS among UTUC patients. However, it is associated with higher risk of high-grade complications. The extent of dissection plays a minor prognostic role, while the positivity of resected nodes has great prognostic value in UTUC.

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Figures

Figure 1.
Figure 1.
The PRISMA flow diagram of the database search and screening processes.
Figure 2.
Figure 2.
A forest plot showing the odds of overall survival between lymph node dissection and non-lymph node dissection groups stratified by follow-up. LND, lymph node dissection.
Figure 3.
Figure 3.
A forest plot showing the odds of complications between lymph node dissection and non-lymph node dissection groups stratified by the Clavien– Dindo classification system. LND, lymph node dissection.
Figure 4.
Figure 4.
A forest plot showing the odds of all-cause mortality between lymph node dissection and non-lymph node dissection groups. LND, lymph node dissection.
Figure 5.
Figure 5.
A forest plot showing the odds of cancer-specific mortality between lymph node dissection and non-lymph node dissection groups. LND, lymph node dissection.
Figure 6.
Figure 6.
A forest plot showing the odds of cancer-specific mortality between complete and incomplete lymph node dissection. LND, lymph node dissection.
Figure 7.
Figure 7.
A forest plot showing the odds of overall survival between negative lymph node and positive lymph node groups stratified by follow-up. pN0, negative lymph node; pN+, positive lymph node.
Figure 8.
Figure 8.
A forest plot showing the odds of disease-free survival between negative lymph node and positive lymph node groups stratified by follow-up. pN0, negative lymph node; pN+, positive lymph node.
Figure 9.
Figure 9.
A forest plot showing the odds of recurrence-free survival between negative lymph node and positive lymph node groups stratified by follow-up. pN0, negative lymph node; pN+, positive lymph node.
Figure 10.
Figure 10.
A forest plot showing the odds of cancer-specific survival between negative lymph node and positive lymph node groups stratified by follow-up. pN0, negative lymph node; pN+, positive lymph node. REML, restricted maximum likelihood method.
Supplementary Figure 1.
Supplementary Figure 1.
A forest plot showing the odds of cancer-specific survival between LND and non-LND groups stratified by follow-up.
Supplementary Figure 2.
Supplementary Figure 2.
A forest plot showing the odds of recurrence-free survival between LND and non-LND groups stratified by follow-up.
Supplementary Figure 3.
Supplementary Figure 3.
A forest plot showing the odds of disease-free survival between LND and non-LND groups stratified by follow-up.
Supplementary Figure 4.
Supplementary Figure 4.
A forest plot showing the odds of any complications between LND and non-LND groups stratified by follow-up.
Supplementary Figure 5.
Supplementary Figure 5.
A forest plot showing the odds of overall survival between LND and non-LND groups.
Supplementary Figure 6.
Supplementary Figure 6.
A forest plot showing the odds of recurrence between LND and non-LND groups.
Supplementary Figure 7.
Supplementary Figure 7.
A forest plot showing the odds of reoperation between LND and non-LND groups.
Supplementary Figure 8.
Supplementary Figure 8.
A forest plot showing the odds of cancer-specific survival between complete and incomplete LND stratified by follow-up.
Supplementary Figure 9.
Supplementary Figure 9.
A forest plot showing the odds of recurrence-free survival between complete and incomplete LND stratified by follow-up.
Supplementary Figure 10.
Supplementary Figure 10.
A forest plot showing the odds of recurrence between complete and incomplete LND.
See this image and copyright information in PMC

References

    1. Rouprêt M, Babjuk M, Burger M, et al. European Association of Urology guidelines on upper urinary tract urothelial carcinoma: 2020 update. Eur Urol. 2021;79(1):62 79. (10.1016/j.eururo.2020.05.042) - DOI - PubMed
    1. American Cancer Society. Cancer facts & figures 2022. Available at: https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-.... Accessed November 28, 2022.
    1. Margulis V, Shariat SF, Matin SF, et al. Outcomes of radical nephroureterectomy: a series from the Upper Tract Urothelial Carcinoma Collaboration. Cancer. 2009;115(6):1224 1233. (10.1002/cncr.24135) - DOI - PubMed
    1. Jazayeri SB, Liu JS, Weissman B, Lester J, Samadi DB, Feuerstein MA. Comparison of Adjuvant Chemotherapy for Upper Tract versus Lower Tract urothelial Carcinoma: A Systematic Review and Meta-Analysis. Curr Urol. 2019;12(4):177 187. (10.1159/000499308) - DOI - PMC - PubMed
    1. Lenis AT, Fero KE, Ojeaburu L, et al. The role of neoadjuvant chemotherapy, lymph node dissection, and treatment delay in patients with muscle-invasive bladder cancer undergoing partial cystectomy. Urol Oncol. 2021;39(8):496.e17 496.e24. (10.1016/j.urolonc.2021.01.016) - DOI - PubMed

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