The role of lymphadenectomy in the treatment of upper tract urothelial carcinoma: a systematic review and meta-analysis

Zuoping Wang ¹ Lei Zheng ¹ Yunxiang Li ^2* Lijian Gan ¹ Chunyang Meng ¹ Kangsen Li ¹ Zhiqiang Zeng ³ Si Ge ³

• ¹ Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, Anhui Province, China
• ² North Sichuan Medical College, Nanchong, China
• ³ Department of Urology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China

Background: The role of lymph node dissection (LND) in the treatment of upper urinary tract urothelial carcinoma (UTUC) is still debated. This study was conducted to find evidence of a higher level of survival benefit based on whether LND was performed during nephroureterectomy (RNU) through systematic evaluation and meta-analysis.Method: This systematic review and meta-analysis was conducted in accordance with the PRISMA statement. A systematic search was performed using Pubmed, Embase, Cochran, and Web of Science libraries for literature published before November 1, 2022. We included all articles with LND performed during RNU and performed a standard meta-analysis of survival outcomes.Results: Twenty-seven eligible studies enrolling 47,874 patients met the inclusion criteria. The combined risk ratio (HR) of these studies showed an overall survival (OS) cancer-specific survival (CSS) and relapse-free survival (RFS) of 0.93 (P=0.123) and 0.79 (P=0.006) and 0.83 (P=0.013), respectively. Further subgroup analysis showed that in patients with muscle-invasive UTUC, the combined HRs for OS, CSS and RFS were 0.87 (0.074), 0.82 (P=0.001) and 0.83 (P=0.003), respectively. In contrast, there was no difference in CSS and RFS in patients with non-muscle invasive UTUC. no difference in OS and RFS between patients with LND negative (cN0) and without LND (cNx), while there was a difference in CSS. patients with LND-like (cN+) had a significantly worse prognosis compared to patients without LND (cN0)Conclusions: This study confirms that LND also has oncologic benefit in patients with UTUC, especially in patients with muscle-invasive UTUC. However, more cohort studies and randomized controlled trials are still needed to determine the specific indications for lymph node dissection and the extent of dissection.Keywords: upper tract urothelial carcinoma (UTUC); lymph node dissection (LND); meta-analysis; radical nephroureterectomy; survival benefits