Abstract: PD06-12
Sources of Funding: Data grant from National Cancer Database, a collaboration between the Commission on Cancer, the American Cancer Society and the American College of Surgeons.

Introduction

There is an inferred benefit to regional lymph node dissection (LND) during radical nephroureterectomy (RNU) for high grade upper tract urothelial carcinoma (HG UTUC). We evaluated trends in utilization of regional LND using the National Cancer Database. We hypothesized that increased use of minimally invasive surgical approaches as well as lower volume RNU centers would be associated with LND utilization.

Methods

We included adults undergoing RNU for pathologically confirmed HG UTUC from 2004-2012. We examined patient demographic, clinical, disease severity (i.e. clinical stage/nodal status), surgical, and hospital-level factors associated receipt of LND using multivariable logistic regression. Sensitivity analyses assessed for consistency of trends in LND use across clinical stage/nodal status as well across center volume of RNU experience (lowest quartile RNU performed over the study period, interquartile, and top quartile).

Results

Of 11,258 patients undergoing RNU for HG UTUC, 2,028/11,258 (18%) were minimally invasive, and 1,009/11,258 (9%) utilized LND. LND was more common in recent years (5.8% in 2004, 12.5% in 2012 [OR 4.7, 95%CI 3.6-6.1 for surgery in 2010-2012 versus 2004-2006]). LND rate for open RNU was 11.6% versus 6.3% for minimally invasive RNU (OR 0.50, 95%CI 0.39-0.67). By 2012, open LND rate rose to 15.8%; minimally invasive LND remained stable at 6.4% (p<0.001). For RNU case volume 79 unique centers were represented, 18 centers were low (<2 cases/year), 40 were intermediate (2 to 4 cases/year) and 21 were high (≥5 cases/year). Center volume was associated with LND (16.9% in top quartile volume centers, compared with 5.5% in lowest quartile volume centers [OR 3.9, 95%CI 3.3-4.6]).

Conclusions

Utilization of regional LND during RNU for HG UTUC increased over time, driven mainly by increased utilization during open RNU. LND was performed at a greater rate in higher volume centers, even after adjustment for disease severity, and may be a quality metric for oncologic management of HG UTUC.

Funding

Data grant from National Cancer Database, a collaboration between the Commission on Cancer, the American Cancer Society and the American College of Surgeons.