Mp38-11 Sociodemographic Factors Predictive of Lymph Node Dissection Performance in Patients With Upper Tract Urothelial Carcinomas

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma II (MP38)1 May 2024MP38-11 SOCIODEMOGRAPHIC FACTORS PREDICTIVE OF LYMPH NODE DISSECTION PERFORMANCE IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMAS Saad Sabbagh, Mohamed Mohanna, Fernando Cabrera, Barbara Ercole, Nicolas Muruve, Alok Shrivastava, Christopher Weight, Surena F. Matin, Rafael Arteta-Bulos, and Alberto Pieretti Saad SabbaghSaad Sabbagh , Mohamed MohannaMohamed Mohanna , Fernando CabreraFernando Cabrera , Barbara ErcoleBarbara Ercole , Nicolas MuruveNicolas Muruve , Alok ShrivastavaAlok Shrivastava , Christopher WeightChristopher Weight , Surena F. MatinSurena F. Matin , Rafael Arteta-BulosRafael Arteta-Bulos , and Alberto PierettiAlberto Pieretti View All Author Informationhttps://doi.org/10.1097/01.JU.0001008700.92603.b1.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Lymph node dissection (LND) is an integral part of the management of upper tract urothelial carcinoma (UTUC). While the survival benefit is unknown, it improves disease staging and guides adjuvant systemic therapy associated with improved outcomes. Therefore, all patients with high-risk disease are recommended to perform LND at the time of surgery. Despite national historical data demonstrating an increase in the utilization of this technique, more than 50% of patients did not have it performed, and contemporary practice data with the establishment of the new guidelines is lacking. Our study aims to analyze the sociodemographic factors predictive of the performance of LND in patients with cT2-4N0M0 UTUC. Additionally, we evaluate the prevalence and the shifting trends in its implementation between 2004 and 2017. METHODS: The National Cancer Database (NCDB) was queried between 2004 and 2017 to identify 4,030 patients with cT2-4N0M0 UTUC who underwent nephroureterectomy. Patients with unknown data on LND were excluded. Patients were then classified into two cohorts based on the performance of LND. Chi-square analysis assessed baseline sociodemographic characteristics, and a multivariable logistic regression was utilized to evaluate factors correlated with LND performance. RESULTS: UTUC was more predominant in male patients in both groups (LND 63% and no LND 59.7%). The most common age of presentation was between 70-79 years old (LND 37.9% and no LND 36.1%). Patients mainly belonged to White and Non-Hispanic racial/ethnic groups. LND was not performed in 79.2% of the patients. Our study showed a 19.2% increase in LND performance, with a 9.2% increase between 2015-2016 (Figure 1). Additionally, surgeons at academic cancer programs (CP) were more likely to perform LND than community CP (OR 1.70, p<0.002). Patients treated at Pacific, Middle Atlantic, and West South-Central facilities had higher chances of receiving a LND (OR 1.977, p 0.001, OR 1.5, p 0.01, and OR 1.919, p 0.007, respectively). CONCLUSIONS: This nationwide study reveals a significant underutilization of LND in patients with UTUC. Academic cancer programs are more likely to perform LND. Due to the complexity of the management of UTUC, consideration should be given to centralizing care in academic centers to improve outcomes. Download PPT Source of Funding: This work was supported by the Maroone Cancer Center, Cleveland Clinic Florida.The authors report no external funding © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e645 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Saad Sabbagh More articles by this author Mohamed Mohanna More articles by this author Fernando Cabrera More articles by this author Barbara Ercole More articles by this author Nicolas Muruve More articles by this author Alok Shrivastava More articles by this author Christopher Weight More articles by this author Surena F. Matin More articles by this author Rafael Arteta-Bulos More articles by this author Alberto Pieretti More articles by this author Expand All Advertisement PDF downloadLoading ...