Patterns of Lymph Node Metastases From Mid and Distal Ureteral Carcinoma

PURPOSE: Accurate mapping of lymph node metastasis (LNM) in upper tract urothelial carcinoma (UTUC) guides lymph node dissection templates and affects staging and adjuvant therapy decisions. LNM patterns for mid and distal ureteral tumors remain undercharacterized. Herein, we map LNM for mid and distal ureteral UTUC. MATERIALS AND METHODS: This was a retrospective single-institution study of 24 patients with clinical or pathological node-positive mid and distal UTUC defined by preoperative imaging, biopsy, and/or pathology following template lymphadenectomy. We recorded tumor laterality/location and nodal location/quantity. Descriptive statistics summarized distributions. RESULTS: Forty-five primary LNMs were documented in 24 patients: right mid (n = 3 patients, 9 LNMs), right distal (n = 8, 14 LNMs), left mid (n = 4, 8 LNMs), and left distal (n = 9, 14 LNMs). Among mid UTUC, LNMs were distributed between retroperitoneal (53%, n = 9/17) and pelvic (47%, n = 8/17) regions. Among distal UTUC, 61% (17/28) involved pelvic nodes with retroperitoneal LNMs comprising 39% (11/28). Among patients with retroperitoneal spread, isolated retroperitoneal LNMs without pelvic nodal involvement were observed in 33% (n = 1/3) and 83% (n = 5/6) of patients with mid and distal UTUC. CONCLUSIONS: This is the largest mapping series for mid and distal ureteral tumors to date. Retroperitoneal LNMs occurred in over half of the patients with mid UTUC and over one-third of patients with distal UTUC, and among patients with retroperitoneal spread, the majority had retroperitoneal LNM without concurrent pelvic LNMs. These findings provide anatomic data to inform putative dissection templates for surgeons and future prospective studies.