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         Journal List > J Korean Med Sci > v.24(4); Aug 2009
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J Korean Med Sci. 2009 Aug;24(4):674-678.
Published online 2009 July 29.  doi: 10.3346/jkms.2009.24.4.674.
Copyright © 2009 The Korean Academy of Medical Sciences
Clinical Significance of Lymph Node Dissection in Patients with Muscle-Invasive Upper Urinary Tract Transitional Cell Carcinoma Treated with Nephroureterectomy
Kang Su Cho,1 Hyun Min Choi,1 Kyochul Koo,1 Sung Jin Park,1 Koon Ho Rha,1 Young Deuk Choi,1 Byung Ha Chung,1 Nam Hoon Cho,2 Seung Choul Yang,1 and Sung Joon Hong1
1Department of Urology, the Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
2Department of Pathology, Yonsei University College of Medicine, Seoul, Korea.

Address for correspondence: Sung Joon Hong, M.D. Department of Urology and the Urological Science Institute, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul 120-752, Korea. Tel: +82.2-2228-2315, Fax: +82.2-312-2538, Email: sjhong346@yuhs.ac
Received June 14, 2008; Accepted September 26, 2008.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Abstract

We investigated the value of lymph node dissection in patients with cN0 muscle-invasive transitional cell carcinoma of the upper urinary tract (UUT-TCC). Medical records of 152 patients with cN0 muscle-invasive UUT-TCC, who underwent nephroureterectomy between 1986 and 2005, were reviewed. Sixty-three patients (41.4%) underwent lymph node dissection. The median number of lymph nodes harvested was 6 (range, 1 to 35), and from these, lymph node involvement was confirmed in 9 patients (14.3%). Locoregional recurrence (LR) and disease-recurrence (DR) occurred in 29 patients and 63 patients, respectively. Fifty-five patients (36.2%) had died of cancer at the last follow-up. The number of lymph nodes harvested was associated with the reduction of LR (χ2trend=6.755, P=0.009), but was not associated with DR (χ2trend=1.558, P=0.212). In the survival analysis, N stage (P=0.0251) and lymph node dissection (P=0.0073) had significant influence on LR, but not on DR or disease-specific survival. However, the number of lymph nodes harvested did not affect LR-free, DR-free, or disease-specific survival. We conclude that lymph node dissection may improve the control of locoregional cancer, as well as staging accuracy, in cN0 muscle-invasive UUT-TCC, but that it does not clearly influence survival.

Keywords: Carcinoma, Transitional Cell, Ureter, Kidney Pelvis, Recurrence, Lymph Node Excision.
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