Patterns of Lymphatic Metastases in Upper Tract Urothelial Carcinoma and Proposed Dissection Templates

No AccessJournal of UrologyAdult Urology1 Dec 2015Patterns of Lymphatic Metastases in Upper Tract Urothelial Carcinoma and Proposed Dissection Templates Surena F. Matin, John P. Sfakianos, Patrick N. Espiritu, Jonathan A. Coleman, and Philippe E. Spiess Surena F. MatinSurena F. Matin Department of Urology, M.D. Anderson Cancer Center, Houston, Texas , John P. SfakianosJohn P. Sfakianos Department of Surgery, Urology Division, Memorial-Sloan Kettering Cancer Center, New York, New York , Patrick N. EspirituPatrick N. Espiritu Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida , Jonathan A. ColemanJonathan A. Coleman Department of Surgery, Urology Division, Memorial-Sloan Kettering Cancer Center, New York, New York , and Philippe E. SpiessPhilippe E. Spiess Department of Surgery, Urology Division, Memorial-Sloan Kettering Cancer Center, New York, New York View All Author Informationhttps://doi.org/10.1016/j.juro.2015.06.077AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Information on patterns of lymph node metastases for upper tract urothelial carcinoma is sparse. We investigated patterns of lymph node metastases in upper tract urothelial carcinoma. Materials and Methods: We performed a retrospective multi-institutional study of 73 patients with N+M0 upper tract urothelial carcinoma who underwent template lymphadenectomy during nephroureterectomy. Anatomical locations of tumor, and number of lymph nodes removed and positive lymph nodes were analyzed and descriptive statistics were performed. Results: On the right side the 20 renal pelvis tumors had lymph node metastases to the hilum in 22.1% of cases, and to paracaval, retrocaval and interaortocaval regions in 44.1%, 10.3% and 20.6%, respectively. The 10 proximal ureter tumors had lymph node metastases to the hilum in 46.2% of cases, and to paracaval and retrocaval regions in 46.2% and 7.7%, respectively. The 2 distal ureter tumors had lymph node metastases equally to the paracaval and pelvic regions. On the left side the 24 renal pelvis tumors had lymph node metastases to the hilum region in 50.0% of cases and to the para-aortic region in 30.0%. The 8 proximal ureter tumors had lymph node metastases to the hilum region in 36.4% of cases and the para-aortic region in 63.6%. The 5 mid ureter tumors had lymph node metastases to the para-aortic, common iliac and internal iliac regions in 40%, 40% and 20% of cases, respectively. The 4 distal ureter tumors had lymph node metastases to the para-aortic, common iliac, external iliac and internal iliac regions in 33.3%, 33.3%, 16.7% and 16.7% of cases, respectively. Interaortocaval involvement from both sides as well as out of field lymph node metastases appeared to occur secondarily. Consolidated templates were constructed based on the available data. Conclusions: Upper tract urothelial carcinoma has characteristic patterns of lymph node metastases depending on the side and anatomical location of the primary tumor, including right-to-left migration and involvement of interaortocaval nodes in the setting of proximal disease. Standardized dissection templates should be prospectively evaluated in multicenter trials to assess morbidity and potential clinical benefit. References 1 : Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol2001; 19: 666. 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Google Scholar © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byMargulis V, Puligandla M, Trabulsi E, Plimack E, Kessler E, Matin S, Godoy G, Alva A, Hahn N, Carducci M, Hoffman-Censits J, Singla N, Ruggeri A, Howard L, McCann J, Delacroix S, Matthew M, Oza Y, Wang J, Gartrell B, Hussain M, Matrana M, Benjamin S, Sonpavde G, Lam E, Bernard B, Zakharia Y, Taylor S, Milowsky M, Ghani S, Singh S, Kane K, Arriaga Y, Morgans A and Chism D (2019) Phase II Trial of Neoadjuvant Systemic Chemotherapy Followed by Extirpative Surgery in Patients with High Grade Upper Tract Urothelial CarcinomaJournal of Urology, VOL. 203, NO. 4, (690-698), Online publication date: 1-Apr-2020.Laguna M (2018) Re: Trends of Lymphadenectomy in Upper Tract Urothelial Carcinoma (UTUC) Patients Treated with Radical NephroureterectomyJournal of Urology, VOL. 200, NO. 1, (26-27), Online publication date: 1-Jul-2018.Laguna M (2018) Re: Effectiveness of Adjuvant Chemotherapy after Radical Nephroureterectomy for Locally Advanced and/or Positive Regional Lymph Node Upper Tract Urothelial CarcinomaJournal of Urology, VOL. 198, NO. 4, (739-740), Online publication date: 1-Oct-2017.Gakis G (2016) Editorial CommentJournal of Urology, VOL. 197, NO. 3 Part 1, (588-588), Online publication date: 1-Mar-2017. Volume 194Issue 6December 2015Page: 1567-1574 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.Keywordslymph nodesdissectionneoplasm metastasisureteral neoplasmskidney neoplasmsAcknowledgmentsGabriela Ramirez assisted with database management. Kaylynn Brooks assisted with figure and manuscript preparation.MetricsAuthor Information Surena F. Matin Department of Urology, M.D. Anderson Cancer Center, Houston, Texas More articles by this author John P. Sfakianos Department of Surgery, Urology Division, Memorial-Sloan Kettering Cancer Center, New York, New York More articles by this author Patrick N. Espiritu Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida More articles by this author Jonathan A. Coleman Department of Surgery, Urology Division, Memorial-Sloan Kettering Cancer Center, New York, New York More articles by this author Philippe E. Spiess Department of Surgery, Urology Division, Memorial-Sloan Kettering Cancer Center, New York, New York More articles by this author Expand All Advertisement PDF downloadLoading ...