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Lymphadenectomy Improves Survival of Patients With Renal Cell Carcinoma and Nodal Metastases

2011; Lippincott Williams & Wilkins; Volume: 185; Issue: 5 Linguagem: Inglês

10.1016/j.juro.2010.12.053

1527-3792

Jared M. Whitson, Catherine R. Harris, Adam C. Reese, Maxwell V. Meng,

Cancer Genomics and Diagnostics

No AccessJournal of UrologyAdult Urology1 May 2011Lymphadenectomy Improves Survival of Patients With Renal Cell Carcinoma and Nodal Metastases Jared M. Whitson, Catherine R. Harris, Adam C. Reese, and Maxwell V. Meng Jared M. WhitsonJared M. Whitson Department of Urology, University of California San Francisco, San Francisco, California , Catherine R. HarrisCatherine R. Harris Department of Urology, University of California San Francisco, San Francisco, California , Adam C. ReeseAdam C. Reese Department of Urology, University of California San Francisco, San Francisco, California , and Maxwell V. MengMaxwell V. Meng Department of Urology, University of California San Francisco, San Francisco, California Helen Diller Family Comprehensive Cancer Center, San Francisco, California View All Author Informationhttps://doi.org/10.1016/j.juro.2010.12.053AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: In a population based cohort we determined whether an increase in the number of lymph nodes removed is associated with improved disease specific survival of patients with renal cell carcinoma treated with nephrectomy. Materials and Methods: Patients in the Surveillance, Epidemiology and End Results database with renal cell carcinoma and no evidence of distant metastases were identified. Those patients included in the study underwent radical or partial nephrectomy with lymphadenectomy. Cox regression analyses were performed to identify factors associated with disease specific survival including an interaction between lymph node status and the number of lymph nodes removed. Results: Between 1988 and 2006, 9,586 patients with renal cell carcinoma met the study inclusion criteria. Median followup was 3.5 years (range 1.4 to 6.8). Of the patients 2,382 (25%) died of renal cell carcinoma, including 1,646 (20%) with lymph node negative disease and 736 (58%) with lymph node positive disease. There was no effect on disease specific survival with increasing the extent of lymphadenectomy in patients with negative lymph nodes (HR 1.0, 95% CI 0.9–1.1, p = 0.93). However, patients with positive lymph nodes had increased disease specific survival with extent of lymphadenectomy (HR 0.8 per 10 lymph nodes removed, 95% CI 0.7–1.0, p = 0.04). An increase of 10 lymph nodes in a patient with 1 positive lymph node was associated with a 10% absolute increase in disease specific survival at 5 years (p = 0.004). Conclusions: This study shows an association between increased lymph node yield and improved disease specific survival of patients with lymph node positive nonmetastatic renal cell carcinoma who underwent lymphadenectomy. Patients at high risk for nodal disease should be considered for regional or extended lymphadenectomy. Clinical variables to predict risk and validation of dissection templates are important areas for future research. References 1 : Cancer Statistics, 2010. CA Cancer J Clin2010; 60: 277. Google Scholar 2 : Tumor size improves the accuracy of TNM predictions in patients with renal cancer. Eur Urol2006; 50: 521. Google Scholar 3 : Prognostic significance of lymph node invasion in patients with metastatic renal cell carcinoma: a population-based perspective. Cancer2009; 115: 5680. 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Google Scholar © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byLaguna M (2018) Re: The Role of Lymph Node Dissection in the Management of Renal Cell Carcinoma: A Systematic Review and Meta-AnalysisJournal of Urology, VOL. 201, NO. 1, (26-27), Online publication date: 1-Jan-2019.Laguna M (2018) Re: Perioperative Morbidity of Lymph Node Dissection for Renal Cell Carcinoma: A Propensity Score-Based AnalysisJournal of Urology, VOL. 200, NO. 3, (495-496), Online publication date: 1-Sep-2018.Laguna M (2016) Re: Characterizing the Impact of Lymph Node Metastases on the Survival Outcome for Metastatic Renal Cell Carcinoma Patients Treated with Targeted TherapiesJournal of Urology, VOL. 195, NO. 4 Part 1, (900-901), Online publication date: 1-Apr-2016.Babaian K, Kim D, Kenney P, Wood C, Wong J, Sanchez C, Fang J, Gerber J, Didic A, Wahab A, Golla V, Torres C, Tamboli P, Qiao W, Matin S, Wood C and Karam J (2018) Preoperative Predictors of Pathological Lymph Node Metastasis in Patients with Renal Cell Carcinoma Undergoing Retroperitoneal Lymph Node DissectionJournal of Urology, VOL. 193, NO. 4, (1101-1107), Online publication date: 1-Apr-2015.Laguna M (2018) Re: Extent of Lymph Node Dissection at Nephrectomy Affects Cancer-Specific Survival and Metastatic Progression in Specific Sub-Categories of Patients with Renal Cell Carcinoma (RCC)Journal of Urology, VOL. 193, NO. 2, (457-457), Online publication date: 1-Feb-2015.Laguna M (2018) Re: Systematic Review of Adrenalectomy and Lymph Node Dissection in Locally Advanced Renal Cell CarcinomaJournal of Urology, VOL. 191, NO. 6, (1728-1730), Online publication date: 1-Jun-2014.Montgomery J and Leibovich B (2018) Lymph Node Excision for Renal CancerJournal of Urology, VOL. 189, NO. 2, (419-421), Online publication date: 1-Feb-2013.Lubahn J, Cost N, Kwon J, Powell J, Yang M, Granberg C, Wickiser J, Rakheja D, Gargollo P, Baker L and Margulis V (2012) Correlation Between Preoperative Staging Computerized Tomography and Pathological Findings After Nodal Sampling in Children with Wilms TumorJournal of Urology, VOL. 188, NO. 4S, (1500-1505), Online publication date: 1-Oct-2012. Volume 185Issue 5May 2011Page: 1615-1620 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.Keywordslymph node excisionsurvivalnephrectomycarcinomarenal cellMetricsAuthor Information Jared M. Whitson Department of Urology, University of California San Francisco, San Francisco, California More articles by this author Catherine R. Harris Department of Urology, University of California San Francisco, San Francisco, California More articles by this author Adam C. Reese Department of Urology, University of California San Francisco, San Francisco, California More articles by this author Maxwell V. Meng Department of Urology, University of California San Francisco, San Francisco, California Helen Diller Family Comprehensive Cancer Center, San Francisco, California Requests for reprints: University of California San Francisco, Box 1695, 1600 Divisadero St., A-632, San Francisco, California 94143. 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