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Renal cell carcinoma and pathologic nodal disease: Implications for American Joint Committee on Cancer staging
Author(s) -
Yu KaiJie,
Keskin Sarp K.,
Meissner Matthew A.,
Petros Firas G.,
Wang Xuemei,
Borregales Leonardo D.,
Gu Cindy,
Tamboli Pheroze,
Matin Surena F.,
Wood Christopher G.,
Karam Jose A.
Publication year - 2018
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.31661
Subject(s) - medicine , hazard ratio , renal cell carcinoma , lymph node , stage (stratigraphy) , cohort , gastroenterology , cancer , carcinoma , confidence interval , paleontology , biology
Background Lymph node (LN) metastases are associated with poor outcomes for patients with renal cell carcinoma (RCC). This study compared the survival outcomes of patients with stage III, node‐positive disease (pT 123 N 1 M 0 ) and patients with stage III, node‐negative disease (pT 3 N 0 M 0 ). Methods A database of 4652 patients with RCC of any histological subtype treated with surgery at The University of Texas MD Anderson Cancer Center from 1993 to 2012 was retrospectively assessed. A total of 115 patients with pT 123 N 1 M 0 disease, 274 patients with pT 3 N 0 M 0 disease, and 523 patients with pT 123 N 0/x M 1 disease were included. Overall survival (OS) and cancer‐specific survival (CSS) were estimated and compared between each cohort. Results Median OS and CSS times were significantly better for pT 3 N 0 M 0 patients than pT 123 N 1 M 0 patients (OS, 10.2 vs 2.4 years, P < .0001; CSS, not reached vs 2.8 years, P < .0001). Similar median OS and CSS times were noted for pT 123 N 1 M 0 and pT 123 N 0/x M 1 patients (OS, 2.4 vs 2.4 years; P = .62; CSS, 2.8 vs 2.4 years; P = .10). In a multivariate analysis, tumor grade (hazard ratio [HR] for OS, 2.47; P < .0001; HR for CSS, 2.99; P < .0001) and pathologic LN involvement (HR for OS, 2.44; P < .0001; HR for CSS, 2.85; P < .0001) were associated with worse OS and CSS. Conclusions Among RCC patients classified with stage III disease, those with pT 123 N 1 M 0 disease had significantly worse survival than those with pT 3 N 0 M 0 disease. OS and CSS were similar for patients with pT 123 N 1 M 0 disease and patients with pT 123 N 0/x M 1 disease (stage IV). If validated, these findings suggest that RCC patients with nodal disease should be reclassified as having stage IV disease.