Impact of lymph node dissection at the time of radical nephrectomy with tumor thrombectomy on oncological outcomes: Results from the International Renal Cell Carcinoma-Venous Thrombus Consortium (IRCC-VTC).
Publisher DOI
PubMed ID
29129353
Abstract
OBJECTIVES
To study the effect of lymph node dissection (LND) at the time of nephrectomy and tumor thrombectomy on oncological outcomes in patients with renal cell carcinoma (RCC) and tumor thrombus.
PATIENTS AND METHODS
The records of 1,978 patients with RCC and tumor thrombus who underwent radical nephrectomy and tumor thrombectomy from 1985 to 2014 at 24 centers were analyzed. None of the patients had distant metastases. Extent and pathologic results of LND were compared with respect to cancer-specific survival (CSS). Multivariable Cox regression models were used to quantify the effect of multiple covariates.
RESULTS
LND was performed in 1,026 patients. In multivariable analysis, the presence of LN metastasis, the number of positive LNs, and LN density were independently associated with cancer-specific mortality (CSM). Clinical node-negative (cN-) disease was documented in 573 patients, 447 of them underwent LND with 43 cN- patients (9.6%) revealing positive LNs at pathology. LN positive cN- patients showed significantly better CSS when compared to LN positive cN+ patients. In multivariable analysis, positive cN status in LN positive patients was a significant predictor of CSM (HR, 2.923; P = 0.015).
CONCLUSIONS
The number of positive nodes harvested during LND and LN density was strong prognostic indicators of CSS, while number of removed LNs did not have a significant effect on CSS. The rate of pN1 patients among clinically node-negative patients was relatively high, and LND in these patients suggested a survival benefit. However, only a randomized trial can determine the absolute benefit of LND in this setting.
To study the effect of lymph node dissection (LND) at the time of nephrectomy and tumor thrombectomy on oncological outcomes in patients with renal cell carcinoma (RCC) and tumor thrombus.
PATIENTS AND METHODS
The records of 1,978 patients with RCC and tumor thrombus who underwent radical nephrectomy and tumor thrombectomy from 1985 to 2014 at 24 centers were analyzed. None of the patients had distant metastases. Extent and pathologic results of LND were compared with respect to cancer-specific survival (CSS). Multivariable Cox regression models were used to quantify the effect of multiple covariates.
RESULTS
LND was performed in 1,026 patients. In multivariable analysis, the presence of LN metastasis, the number of positive LNs, and LN density were independently associated with cancer-specific mortality (CSM). Clinical node-negative (cN-) disease was documented in 573 patients, 447 of them underwent LND with 43 cN- patients (9.6%) revealing positive LNs at pathology. LN positive cN- patients showed significantly better CSS when compared to LN positive cN+ patients. In multivariable analysis, positive cN status in LN positive patients was a significant predictor of CSM (HR, 2.923; P = 0.015).
CONCLUSIONS
The number of positive nodes harvested during LND and LN density was strong prognostic indicators of CSS, while number of removed LNs did not have a significant effect on CSS. The rate of pN1 patients among clinically node-negative patients was relatively high, and LND in these patients suggested a survival benefit. However, only a randomized trial can determine the absolute benefit of LND in this setting.
Date Issued
2018-02
Publication Type
Article
Subject(s)
Subjects
Inferior vena cava Lymph node metastasis Lymphadenectomy Renal cell carcinoma Survival Vena cava tumor thrombectomy
Language(s)
en
Author(s)
Tilki, Derya | |
Chandrasekar, Thenappan | |
Capitanio, Umberto | |
Ciancio, Gaetano | |
Daneshmand, Siamak | |
Gontero, Paolo | |
Gonzalez, Javier | |
Haferkamp, Axel | |
Hohenfellner, Markus | |
Huang, William C | |
Linares Espinós, Estefania | |
Lorentz, Adam | |
Martinez-Salamanca, Juan I | |
Master, Viraj A | |
McKiernan, James M | |
Montorsi, Francesco | |
Novara, Giacomo | |
Pahernik, Sascha | |
Palou, Juan | |
Pruthi, Raj S | |
Rodriguez-Faba, Oscar | |
Russo, Paul | |
Scherr, Douglas S | |
Shariat, Shahrokh F | |
Terrone, Carlo | |
Vera-Donoso, Cesar | |
Zigeuner, Richard | |
Libertino, John A | |
Evans, Christopher P |
Additional Credits
Journal
Urologic oncology - seminars and original investigations
Publisher
Elsevier
ISSN
1078-1439
Access(Rights)
restricted