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The impact of lymph node dissection and positive lymph nodes on cancer‐specific mortality in contemporary pT 2‐3 non‐metastatic renal cell carcinoma treated with radical nephrectomy
Author(s) -
Marchioni Michele,
Bandini Marco,
Pompe Raisa S.,
Martel Tristan,
Tian Zhe,
Shariat Shahrokh F.,
Kapoor Anil,
Cindolo Luca,
Briganti Alberto,
Schips Luigi,
Capitanio Umberto,
Karakiewicz Pierre I.
Publication year - 2018
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.14024
Subject(s) - medicine , interquartile range , nephrectomy , renal cell carcinoma , hazard ratio , lymph node , urology , proportional hazards model , lymph , dissection (medical) , kidney cancer , cancer , surgery , oncology , kidney , pathology , confidence interval
Objective To assess the effect of lymph node dissection ( LND ), number of removed nodes ( NRN ), and number of positive nodes ( NPN ), on cancer‐specific mortality ( CSM ) in contemporary vs historical patients with pT 2–3 N any M 0 renal cell carcinoma ( RCC ) treated with radical nephrectomy ( RN ). Patients and Methods Within the Surveillance, Epidemiology, and End Results database (2001–2013), we identified patients with non‐metastatic pT 2–3 N any RCC who underwent RN with or without LND . Kaplan–Meier analyses and multivariable Cox regression models with propensity score weighting for inverse probability of treatment were used. Results Of 25 357 patients, 24.8% underwent LND (2001–2007: 3 167 patients vs 2008–2013: 3 133 patients). The median NRN was 3 (interquartile range [IQR]: 1‐7). Positive nodes were identified in 17.1%: 9.3% of pT 2 and 21.6% of pT 3 patients, who underwent LND . The median NPN was 2 (IQR: 1‐3). In multivariable models, LND did not decrease CSM (hazard ratio [ HR ] 1.29; P < 0.001). LND extent, defined as NRN , did not decrease CSM ( HR 0.94; P = 0.3). Finally, multivariable models testing the effect of NPN showed increased CSM in pT 3 but not in pT 2 patients ( HR 1.29 and 1.58, P = 0.02 and P = 0.1, respectively). NRN exerted a protective effect on CSM in patients with positive nodes ( HR 0.98; P = 0.007). Conclusion In contemporary and historical patients LND or its extent do not protect from CSM . However, the NPN increases the rate of CSM in pT 3 patients. Consequently, LND and its extent appear to have little if any therapeutic value in pT 2–3 N any M 0 patients, besides its prognostic impact. High‐risk non‐metastatic patients may represent a target population for a multi‐institutional prospective trial.