Effect of lymph node dissection on the outcomes of upper tract urothelial carcinomas: a meta-analysis

Abstract

A systematic search was conducted in PubMed, Cochrane Library. 6032 patients were included. There was no significant difference in survival between LND and NLND (non-lymph node dissection) among the patients. However, the patients in the LND group had more advanced tumour stages and grades (p < 0.001). In addition, among the muscle-invasive patients, LND demonstrated remarkable CSS improvement compared with NLND (HR: 2.19; 95% CI: 1.26–3.80; p = 0.005). Moreover, subgroup analyses found that patients with muscle-invasive UTUC had better CSS (HR: 1.22; 95% CI: 1.02–1.45; p < 0.001) than those patients with pN0 compared to pNx (NLND). In terms of RFS, the results showed no difference in the survival rates between pN0 and pNx patients in the subgroup of patients with muscle-invasive UTUC (HR: 1.40; 95% CI: 0.84–2.23; p = 0.19). Our meta-analysis supports that LND may prolong the CSS and RFS of UTUC, especially for patients with muscle-invasive UTUC.

Keywords::

• lymph node dissection
• radical nephroureterectomy
• recurrence
• survival
• urinary tract cancer
• urothelial carcinoma

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Controversy remains whether lymph node dissection (LND) should be performed for the upper tract urothelial carcinoma (UTUC).

• We assess whether patients who achieved LND had improved cancer-specific survival (CSS) or recurrence-free survival (RFS) compared with patients who did not achieve LND. In addition, subgroup analyses were performed to determine which types of patients with UTUC should be treated with LND.

• A systematic search was conducted in PubMed, Cochrane Library. CSS or RFS was estimated using the hazard ratio (HR). A meta-analysis was performed using the fixed-effects model or random-effects model. The quality of evidence was assessed using the Newcastle-Ottawa Scale.

• A total of 6032 patients were included. There was no significant difference in survival between LND and non-LND (NLND) among the patients. However, the patients in the LND group had more advanced tumor stages and grades (p < 0.001).

• Among the muscle-invasive patients, LND demonstrated remarkable CSS improvement compared with NLND (HR: 2.19; 95% CI: 1.26–3.80; p = 0.005). Moreover, subgroup analyses found that patients with muscle-invasive UTUC had better CSS (HR: 1.22; 95% CI: 1.02–1.45; p < 0.001) than those patients with pN0 compared with pNx (NLND).

• In terms of RFS, the results showed no difference in the survival rates between pN0 and pNx patients in the subgroup of patients with muscle-invasive UTUC (HR: 1.40; 95% CI: 0.84–2.23; p = 0.19).

• Our meta-analysis supports that LND may prolong the CSS and RFS of UTUC, especially for patients with muscle-invasive UTUC.

Notes