Table 3. LND outcomes.
| Study | Study type | N | Yes LND | No LND | Outcomes | Comments |
|---|---|---|---|---|---|---|
| Komatsu 1997 (45) | Retrospective review | 36 | 36 | – | pN+ 5-year OS =21% | – |
| No disease-related pT0 deaths | ||||||
| Miyake 1998 (47) | Retrospective review | 72 | 35 | 37 | 5-year OS pN+ =0% | LND not associated with improved OS |
| 5-year OS + LND =58% | pN+ poorer outcomes than pN0 | |||||
| 5-year OS – LND =50% | ||||||
| Roscigno 2008 (48) | Retrospective review | 132 | 95 | 37 | 5-year CSS pNx < pN0 (48% vs. 73%, P=0.001) | Improved OS with pN0, no difference in OS for pN+ and pNx |
| 5-year CSS pN+ =39% | ||||||
| Roscigno 2009 (49) | Multi-institutional retrospective review | 1,130 | 552 | 578 | 5-year CSS pN+ vs. pNx =35% vs. 69% (P<0.001) | CSS did not differ b/t pN0 and pNx for pT1, but pNx was worse for pT2–4 |
| 5-year CSS pNx vs. pN0 =69% vs. 77% (P=0.024) | ||||||
| Lughezzani 2010 (50) | SEER review | 2,824 | 1,835 | 747 | 5-year CSS pNx =81% | No survival benefit related to LND in pN0 when compared to pNx |
| 5-year CSS pN0 =78% | ||||||
| CSS pNx vs. pN0 (HR: 1.19, P=0.09) | ||||||
| Mason 2012 (51) | Multi-institutional retrospective review | 1,029 | 276 | 753 | pN+ vs. pNx OS HR 2.70; DSS HR 2.83; RFS 2.03 | LND appears to provide more accurate staging and survival predictions; unclear if LND independently improves survival |
| pN+ vs. pN0 OS HR 2.97; DSS 2.94; RFS 2.01 | ||||||
| pN0 vs. pNx no difference in OS, DSS, RFS | ||||||
| Yang 2014 (52) | Systematic review | 5,739 | 3,243 | 2,496 | All patients + LND vs. – LND HR 0.95 | No CSS difference in all patients, but significant improvement seen with pT2–4 patients on subgroup analysis |
| pT2–4 + LND vs. − LND CSS HR 2.19 (P=0.005) | ||||||
| Chappidi 2016 (53) | SEER review | 2,862 | 721 | 2,141 | 1st quartile LN removed 5-year CSS 78% | Increased LN yield associated with improved CSS |
| 2nd/3rd quartile LN removed 5-year CSS 60% | ||||||
| Dominguez-Escrig 2017 (54) | Systematic review | – | – | – | Renal pelvis ≥ pT2c + LND vs. – LND 3-year CSS 90% vs. 52% (HR 0.23, P=0.01) | Survival benefit to LND was seen with high stage renal pelvis UTUC |
| Ureteral tumor + LND vs. – LND 3-year CSS 54% vs. 72% (HR 0.99, P=0.99) | Unclear benefit to ureteral tumors | |||||
| Ikeda 2017 (55) | Retrospective review | 399 | 222 | 177 | 5-year DFS: pN0 > pNx > pN+ (78% vs. 62% vs. 33%) | Improved DFS and CSS with ≥ pT3 pN0 vs. pNx tumors |
| 5-year CSS: pN0 > pNx > pN+ (85% vs. 73% vs. 44%) | No difference in DFS or CSS for pT2 | |||||
| ≥ pT3 pN0 vs. pNx DFS =66% vs. 37%; CSS =76% vs. 46%; P=0.001) | ||||||
| Inokuchi 2017 (56) | Multi-institutional retrospective | 2,037 | 1,046 | 991 | 5-year CSS + LND vs. – LND: HR =1.36 (0.88–2.09) | No therapeutic benefit to LND although it may provide improved ability to predict prognosis |
| 5-year OS + LND vs. – LND: HR = 1.28 (0.87–1.89) | ||||||
| Guo 2018 (57) | Systematic review | 7,516 | – | – | CSS pN+ vs. pN0: HR =3.38 (1.94–5.89) | LND allows for improved staging and prognosis prediction |
| RFS pN+ vs. pN0: HR =3.46 (2.00–5.97) | Survival benefit unclear | |||||
| ≥ pT2 CSS pN+ vs. pN0: HR =3.27 (2.83–3.78) | ||||||
| ≥ pT2 DFS pN+ vs. pN0: HR =2.10 (1.05–4.20) |
LND, lymph node dissection; OS, overall survival; CSS, cancer-specific survival; SEER, Surveillance, Epidemiology and End Results; HR, hazard ratio; RFS, recurrence-free survival; DSS, disease-specific survival; LN, lymph node; UTUC, upper tract urothelial carcinoma; DFS, disease-free survival.