Oncologic outcomes of laparoscopic radical nephroureterectomy in conjunction with template-based lymph node dissection : An extended follow-up study

Matsumoto, Ryuji; Abe, Takashige; Takada, Norikata et al.

Urologic oncology, 2020, 38(12), 933.e13

Permalink : https://hdl.handle.net/2115/80434

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https://doi.org/10.1016/j.urolonc.2020.05.013     13

論文情報

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アクセス権
open access
URI
https://hdl.handle.net/2115/80434
タイトル
Oncologic outcomes of laparoscopic radical nephroureterectomy in conjunction with template-based lymph node dissection : An extended follow-up study
著者
Matsumoto, Ryuji ; Abe, Takashige ; Takada, Norikata ; Minami, Keita ; Harabayashi, Toru ; Nagamori, Satoshi ; Hatanaka, Kanako C. ; Yamashiro, Katsushige ; Kikuchi, Hiroshi ; Osawa, Takahiro ; Maruyama, Satoru ; Shinohara, Nobuo
e-Rad_Researcher
10762536
著者名
Matsumoto, Ryuji
e-Rad_Researcher
10399842
著者名
Abe, Takashige
著者名
Takada, Norikata
著者名
Minami, Keita
e-Rad_Researcher
70301900
著者名
Harabayashi, Toru
著者名
Nagamori, Satoshi
著者名
Hatanaka, Kanako C.
著者名
Yamashiro, Katsushige
e-Rad_Researcher
20828305
著者名
Kikuchi, Hiroshi
e-Rad_Researcher
60374443
著者名
Osawa, Takahiro
e-Rad_Researcher
80507591
著者名
Maruyama, Satoru
e-Rad_Researcher
90250422
著者名
Shinohara, Nobuo
言語
英語
キーワード
Urothelial carcinoma
Upper urinary tract
Lymph node dissection
Micrometastasis
Relapse pattern
発行日
2020-12
出版者
Elsevier
収録物名
Urologic oncology
巻(号)
38(12)
ページ
933.e13
抄録
Objectives: This study investigated the relapse pattern and oncologic outcomes after laparoscopic nephroureterectomy with template-based lymph node dissection (LND) in patients with clinically node-negative (cN0) upper urinary tract urothelial carcinoma. The frequency of lymph node metastasis, including micrometastases, was also evaluated. Methods and materials: A total of 105 patients with cTa-3N0M0 upper urinary tract urothelial carcinoma were analyzed, all of whom underwent regional LND during laparoscopic nephroureterectomy. Of those patients, 96 (91%) underwent complete LND in accordance with an anatomical template-based rule. We collected patient characteristics, pathological data, and follow-up data from medical charts. Micrometastases were assessed by pan-cytokeratin immunohistochemistry. Nonurothelial recurrence-free survival and cancer-specific survival were estimated using the Kaplan-Meier method. Results: The median number of lymph nodes removed was 12 (range, 1-59). Lymph node metastasis was identified by routine pathological examination in 7 (7/105, 6.7%) patients. Pan-cytokeratin immunohistochemistry revealed micrometastases in 5 additional patients (pNmicro +: 5/105, 4.8%). Nonurothelial disease recurrence was observed in 21 (20%) patients at a median of 10 months (range: 1- 33) after surgery. Distant metastasis was dominant (15/105, 14.3%), followed by locoregional recurrence (5/105, 4.8%) and both (1/105, 0.95%). The 5-year nonurothelial recurrence-free survival rates were 84.8% for pN0, 53.3% for pNmicro+, and 19.1% for pN+ (3-sample log-rank test, P < 0.0001). The 5-year cancer-specific survival rates were 95.0% for pN0, 53.3% for pNmicro+, and 23.8% for pN+ (P < 0.0001). Conclusions: Our observation showed that template-based LND could contribute to precise disease staging and better local disease control probably by eliminating nodal disease, compared with previous studies. The survival impact and ideal management of pNmicro+ disease should be evaluated in a larger cohort. (C) 2020 The Authors. Published by Elsevier Inc.
資源タイプ
学術雑誌論文
出版タイプ
Version of Record
権利情報
Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
PISSN
1078-1439
関連情報 (isIdenticalTo)
出版社版DOI
https://doi.org/10.1016/j.urolonc.2020.05.013