Pathologic Predictors of Survival During Lymph Node Dissection for Metastatic Renal-Cell Carcinoma: Results From a Multicenter Collaboration

Juan Chipollini, E. Jason Abel, Charles C. Peyton, David C. Boulware, Jose A. Karam, Vitaly Margulis, Viraj A. Master, Kamran Zargar-Shoshtari, Surena F. Matin, Wade J. Sexton, Jay D. Raman, Christopher G. Wood, Philippe E. Spiess

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3 Scopus citations

Abstract

Purpose: To determine the therapeutic value of lymph node dissection (LND) during cytoreductive nephrectomy (CN) and assess predictors of cancer-specific survival (CSS) in metastatic renal-cell carcinoma. Patients and Methods: We identified 293 consecutive patients treated with CN at 4 academic institutions from March 2000 to May 2015. LND was performed in 187 patients (63.8%). CSS was estimated by the Kaplan-Meier method for the entire cohort and for a propensity score-matched cohort. Cox proportional hazards regression was used to evaluate CSS in a multivariate model and in an inverse probability weighting-adjusted model for patients who underwent dissection. Results: Median follow-up was 12.6 months (interquartile range, 4.47, 30.3), and median survival was 15.9 months. Of the 293 patients, 187 (63.8%) underwent LND. One hundred six patients had nodal involvement (pN+) with a median CSS of 11.3 months (95% confidence interval [CI], 6.6, 15.9) versus 24.2 months (95% confidence interval, 14.1, 34.3) for pN- patients (log-rank P = .002). The hazard ratio for LND was 1.325 (95% CI, 1.002, 1.75) for the whole cohort and 1.024 (95% CI, 0.682, 1.537) in the propensity score-matched cohort. Multivariate analysis revealed that number of positive lymph nodes (P < .001) was a significant predictor of worse CSS. Conclusion: For patients with metastatic renal-cell carcinoma undergoing CN with lymphadenectomy, the number of nodes positive was predictive of survival at short-term follow-up. However, nonstandardized lymphadenectomy only provided prognostic information without therapeutic benefit. Prospective studies with standardized templates are required to further ascertain the therapeutic value of LND.

Original languageEnglish (US)
JournalClinical Genitourinary Cancer
DOIs
Publication statusAccepted/In press - Jan 1 2017

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Keywords

  • Cytoreductive nephrectomy
  • Lymph node dissection
  • Lymphadenectomy
  • Metastatic renal cell carcinoma
  • Node density

ASJC Scopus subject areas

  • Oncology
  • Urology

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