The benefit of lymph node dissection (LND) during radical nephroureterectomy (RNU) in lymph node (LN)-negative (cN0/pN0) UTUC remains controversial. We aimed to assess the association between LND and its extent and survival in LN-negative UTUC. The Surveillance, Epidemiology, and End Results database was searched to identify patients with non-metastatic chemotherapy-naïve cN0/pNx or pN0 UTUC who underwent RNU +/− LND between 2004 and 2019. Overall, 4649 patients with cN0/pNx or pN0 UTUC were analyzed, including 909 (19.55%) individuals who had LND. Among them, only in 368 patients (7.92%) was LND extended to at least four LNs, and the remaining 541 patients (11.64%) have had < four LNs removed. In the whole cohort, LND contributed to better cancer-specific survival (CSS) and overall survival (OS). Furthermore, a propensity score-matched analysis adjusted for confounders confirmed that improved CSS and OS was achieved only when ≥ four LNs had been removed, especially in muscle-invasive UTUC. A multivariable analysis further confirmed an association between the extent of LND and CSS. To conclude, adequate LND during RNU was associated with improved OS and CSS in LN-negative UTUC, particularly in muscle-invasive stage. This underscores that a sufficient LN yield is required to reveal a therapeutic benefit in patients undergoing RNU.
在淋巴结阴性（cN0/pN0）上尿路尿路上皮癌患者中，根治性肾输尿管切除术同期行淋巴结清扫术的临床获益仍存争议。本研究旨在评估淋巴结清扫范围与淋巴结阴性上尿路尿路上皮癌患者生存预后的关联。通过检索美国监测、流行病学和最终结果数据库，筛选2004年至2019年间接受根治性肾输尿管切除术（联合或不联合淋巴结清扫）的非转移性初治cN0/pNx或pN0期上尿路尿路上皮癌患者。最终纳入分析的4649例患者中，909例（19.55%）接受了淋巴结清扫。其中仅368例（7.92%）清扫淋巴结数量≥4枚，其余541例（11.64%）清扫淋巴结数量<4枚。全队列分析显示，淋巴结清扫与更优的癌症特异性生存期和总生存期相关。经倾向评分匹配校正混杂因素后证实，仅当清扫淋巴结数量≥4枚时才能显著改善癌症特异性生存期和总生存期，这一效应在肌层浸润性上尿路尿路上皮癌中尤为显著。多变量分析进一步确认了淋巴结清扫范围与癌症特异性生存期的关联。综上所述，根治性肾输尿管切除术中实施充分的淋巴结清扫可改善淋巴结阴性上尿路尿路上皮癌患者的总生存期和癌症特异性生存期，对肌层浸润期患者效果尤为显著。这提示在根治性肾输尿管切除术中需获取足够数量的淋巴结才能实现治疗获益。
肿瘤(癌症)患者之家