Benefit of lymph node dissection in cN plus patients in the treatment of upper tract urothelial carcinoma: Analysis of ROBUUST registry
Recommended Citation
Tufano A, Passaro F, Spena G, Bignante G, Wu Z, Simone G, Ferro M, Singla N, Sundaram CP, Derweesh IH, Margulis V, Abdollah F, Djaladat H, Mehrazin R, Gonzalgo ML, Correa A, Rais-Bahrami S, Yoshida T, Antonelli A, Porpiglia F, Autorino R, Perdonà S. Benefit of lymph node dissection in cN plus patients in the treatment of upper tract urothelial carcinoma: Analysis of ROBUUST registry. Eur Urol 2025; 87(S1):S861.
Document Type
Conference Proceeding
Publication Date
3-1-2025
Publication Title
Eur Urol
Abstract
Introduction & Objectives: The benefit of lymph node dissection (LND) in surgically treated upper tract urothelial carcinoma (UTUC) patients who present with clinically positive nodes at diagnosis remains unknown. Our aim is to assess survival differences in cN+ patients with upper tract urothelial carcinoma (UTUC) who underwent radical nephroureterectomy (RNU) + lymph node dissection (LND) vs. RNU alone. Materials & Methods: We identified 280 patients diagnosed with UTUC who underwent RANU from the ROBUUST registry between 2017 and 2024. Among those, 176 (62.9%) patients underwent LND. Kaplan-Meier curves were used to estimate overall survival (OS) in cN+ patients receiving RANU with and without LND. Additionally, Cox proportional hazards regression was conducted to evaluate the impact of LND status on OS after adjusting for other covariates. Results: At a median follow-up of 20 months (IQR: 5.00-40.1) the OS rates were 50.6% for patients who underwent RNU + LND compared to 47.9% for those who underwent RNU alone, demonstrating no significant survival advantage (log-rank p = 0.03). The multivariate Cox regression analysis revealed that LND did not significantly impact OS (HR: 0.97, 95% CI: 0.46–2.02, p = 0.93). Age over 70 years was a significant predictor of mortality (HR: 1.93, 95% CI: 1.01–3.70, p = 0.05). Other covariates, including adjuvant chemotherapy (HR: 1.49, 95% CI: 0.78–2.86, p = 0.23), tumor grade (HR: 0.81, 95% CI: 0.36–1.83, p = 0.61), and pathological stage (HR: 1.39, 95% CI: 0.60–3.20, p = 0.44), did not show significant associations with OS. However, patients with pN1 (HR: 4.42, 95% CI: 2.22–8.77, p = 0.001) and those classified as pN2/3 (HR: 6.18, 95% CI: 0.71–53.41, p = 0.10) exhibited increased mortality risk. Conclusions: In cN+ patients with UTUC, the addition of LND to RNU did not significantly improve overall survival. These findings suggest that LND may not confer a survival benefit, highlighting the need for further research to refine treatment strategies in UTUC management.
Volume
87
Issue
S1
First Page
S861
