Portal de Periódicos da CAPES

Can a Durable Disease-Free Survival be Achieved With Surgical Resection in Patients With Pathological Node Positive Renal Cell Carcinoma?

2011; Lippincott Williams & Wilkins; Volume: 186; Issue: 4 Linguagem: Inglês

10.1016/j.juro.2011.05.051

1527-3792

Scott E. Delacroix, Brian F. Chapin, Jaclyn J. Chen, Graciela M. Nogueras‐González, Pheroze Tamboli, Surena F. Matin, Christopher G. Wood,

Renal and related cancers

No AccessJournal of UrologyAdult Urology1 Oct 2011Can a Durable Disease-Free Survival be Achieved With Surgical Resection in Patients With Pathological Node Positive Renal Cell Carcinoma? Scott E. Delacroix, Brian F. Chapin, Jaclyn J. Chen, Graciela M. Nogueras-Gonzalez, Pheroze Tamboli, Surena F. Matin, and Christopher G. Wood Scott E. DelacroixScott E. Delacroix Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas Equal study contribution. More articles by this author , Brian F. ChapinBrian F. Chapin Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas Equal study contribution. More articles by this author , Jaclyn J. ChenJaclyn J. Chen Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas More articles by this author , Graciela M. Nogueras-GonzalezGraciela M. Nogueras-Gonzalez Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas More articles by this author , Pheroze TamboliPheroze Tamboli Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas More articles by this author , Surena F. MatinSurena F. Matin Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas More articles by this author , and Christopher G. WoodChristopher G. Wood Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.05.051AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Patients with isolated regional nodal metastases from renal cell carcinoma are a distinct cohort for which resection of involved lymph nodes may be therapeutic. We assessed the outcomes of patients treated at our institution with pathological node positive renal cell carcinoma without concomitant metastatic disease (TanyN+M0). Materials and Methods: A total of 2,521 patients with nonmetastatic renal cell carcinoma (TanyNanyM0) of any histological subtype treated with nephrectomy were identified between 1995 and 2009. Pathological regional node positive disease in the absence of clinically detectable metastases (TanyN1-2M0) was present in 68 patients (2.7%) and these patients formed our study cohort. Patients were assessed for timing and location of recurrence, disease specific survival and overall survival. Multivariate Cox regression analysis was performed to define factors predictive of recurrence and overall survival. Results: Of the 68 patients with TanyN1-2M0 renal cell carcinoma 22.1% were free of disease at a median followup of 43.5 months. In those patients experiencing recurrence, disease was detected within the first 4 months after surgery in 51% and was most commonly detected at multiple organ sites. The Kaplan-Meier estimated 5-year overall survival and disease specific survival was 37% and 39%, respectively. Predictors of a favorable outcome included an Eastern Cooperative Oncology Group performance status of 0, single node involvement, absence of sarcomatoid features and papillary histology. Conclusions: Nephrectomy with lymph node dissection can provide a durable disease-free survival in a proportion of patients with regionally advanced renal cell carcinoma and limited lymph node metastases. References 1 : The results of radical nephrectomy for renal cell carcinoma. J Urol1969; 101: 297. Link, Google Scholar 2 : The role of lymphadenectomy in renal cell carcinoma. Curr Opin Urol2009; 19: 465. Google Scholar 3 : Role of lymphadenectomy in genitourinary cancer. AUA Update Series2009; 28: 12. Google Scholar 4 : Radical nephrectomy with and without lymph-node dissection: final results of European Organization for Research and Treatment of Cancer (EORTC) randomized phase 3 trial 30881. Eur Urol2009; 55: 28. Google Scholar 5 : A protocol for performing extended lymph node dissection using primary tumor pathological features for patients treated with radical nephrectomy for clear cell renal cell carcinoma. J Urol2004; 172: 465. Link, Google Scholar 6 : Renal cell carcinoma with retroperitoneal lymph nodes: role of lymph node dissection. J Urol2003; 169: 2076. Link, Google Scholar 7 : Renal cell carcinoma with nodal metastases in the absence of distant metastatic disease (clinical stage TxN1–2M0): the impact of aggressive surgical resection on patient outcome. J Urol2006; 175: 864. Link, Google Scholar 8 : Reassessing the current TNM lymph node staging for renal cell carcinoma. Eur Urol2006; 49: 324. Google Scholar 9 : Enlargement of regional lymph nodes in renal cell carcinoma is often not due to metastases. J Urol1990; 144: 243. Link, Google Scholar 10 : The role of lymph node dissection in renal cell carcinoma: the pendulum swings back. Cancer J2008; 14: 308. Google Scholar 11 : Patients with renal cell carcinoma nodal metastases can be accurately identified: external validation of a new nomogram. Int J Cancer2007; 121: 2556. Google Scholar 12 : Lack of retroperitoneal lymphadenopathy predicts survival of patients with metastatic renal cell carcinoma. J Urol2001; 166: 68. Link, Google Scholar 13 : Renal cell carcinoma with retroperitoneal lymph nodes: Impact on survival and benefits of immunotherapy . Cancer2003; 97: 2995. Google Scholar 14 : AJCC Cancer Staging Manual. New York: Springer2002. Google Scholar 15 : 2004 WHO classification of the renal tumors of the adults. Eur Urol2006; 49: 798. Google Scholar 16 : Classification of renal cell carcinoma: Workgroup No. 1: Union Internationale Contre le Cancer (UICC) and the American Joint Committee on Cancer (AJCC) . Cancer1997; 80: 987. Google Scholar 17 : Value of frozen section analysis of enlarged lymph nodes during radical nephrectomy for renal cell carcinoma. Urology2009; 74: 364. Google Scholar 18 : Lymph node dissection at the time of radical nephrectomy for high-risk clear cell renal cell carcinoma: indications and recommendations for surgical templates. Eur Urol2011; 59: 18. Google Scholar 19 : Randomized trial of adjuvant thalidomide versus observation in patients with completely resected high-risk renal cell carcinoma. Urology2009; 73: 337. Google Scholar 20 : Analysis of clinicopathologic predictors of oncologic outcome provides insight into the natural history of surgically managed papillary renal cell carcinoma. Cancer2008; 112: 1480. Google Scholar © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited bySharma V, Wymer K, Joyce D, Moriarty J, Khanna A, Borah B, Thompson R, Costello B, Leibovich B and Boorjian S (2022) Cost-effectiveness of Adjuvant Pembrolizumab After Nephrectomy for High-risk Renal Cell Carcinoma: Insights for Patient Selection From a Markov ModelJournal of Urology, VOL. 209, NO. 1, (89-98), Online publication date: 1-Jan-2023.Laguna 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.Gershman B, Thompson R, Boorjian S, Larcher A, Capitanio U, Montorsi F, Carenzi C, Bertini R, Briganti A, Lohse C, Cheville J and Leibovich B (2017) Radical Nephrectomy with or without Lymph Node Dissection for High Risk Nonmetastatic Renal Cell Carcinoma: A Multi-Institutional AnalysisJournal of Urology, VOL. 199, NO. 5, (1143-1148), Online publication date: 1-May-2018.Abel E, Heckman J, Hinshaw L, Best S, Lubner M, Jarrard D, Downs T, Nakada S, Lee F, Huang W and Ziemlewicz T (2015) Multi-Quadrant Biopsy Technique Improves Diagnostic Ability in Large Heterogeneous Renal MassesJournal of Urology, VOL. 194, NO. 4, (886-891), Online publication date: 1-Oct-2015.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 (2014) 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 (2014) 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. Volume 186Issue 4October 2011Page: 1236-1241 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.Keywordslymph node excisioncarcinoma, renal celllymph nodesMetricsAuthor Information Scott E. Delacroix Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas Equal study contribution. More articles by this author Brian F. Chapin Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas Equal study contribution. More articles by this author Jaclyn J. Chen Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas More articles by this author Graciela M. Nogueras-Gonzalez Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas More articles by this author Pheroze Tamboli Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas More articles by this author Surena F. Matin Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas More articles by this author Christopher G. Wood Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas More articles by this author Expand All Advertisement PDF downloadLoading ...