BERKELEY, CA (UroToday.com) - With metastatic progression, the prognosis for patients with renal cell carcinoma plummets precipitously from what is considered a relatively good outcome with surgical therapy. Nodal metastases, in particular, appear to be associated with a very poor prognosis, despite aggressive surgical approaches and the application of adjuvant therapy. Here, Karakiewicz and colleagues report on the experience of 10 institutions with node positive RCC patients, in the absence of distant metastases, treated with aggressive surgical therapy.

Of 3907 patients with RCC treated over a 17 year period, 171 (4.4%) were identified as having nodal metastases in the absence of distant metastases. The median follow up for these patients was 1.3 years. The median age was 65.2 years (range 14-85), 71.3% were men, and 70.8% had pT3 disease. Mean tumor size was 8.9cm, 86% were clear cell RCC, and 72.5% were high grade. Regarding symptoms, 30.4% of patients were asymptomatic, 36.3% had local symptoms, and 33.3% had systemic symptoms from their outcome in this group of node positive RCC patients. In univariate analysis, symptom classification was the most informative prognostic factor predicting outcome (p less than 0.001). In their multivariate analysis, the most important independent predictors of outcome were symptom classification (p less than 0.001), followed by Fuhrman grade (p=0.02), and histology (p=0.04). In particular, patients that presented with systemic symptoms from their tumor had an extremely poor prognosis following surgical therapy. The 5 year RCC specific survival for the entire group was 39.3% following surgery.

As demonstrated in previous reports, the authors conclude that node metastases from RCC represent a particularly virulent biology in RCC. While aggressive surgical management can, in select cases, achieve reasonably good outcomes, the presence of symptoms from the tumor, particularly systemic symptoms, portends a poor prognosis.

Karakiewicz PI, Trinh QD, Bhojani N, Bensalah K, Salomon L, de la Taille A, Tostain J, Cindolo L, Altieri V, Ficarra V, Schips L, Zigeuner R, Mulders PFA, Valeri A, Descotes JL, Mejean A, Patard JJ

Euro Ur Epub December 14, 2006

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