San Diego, CA USA (UroToday.com) In this session, Dr. Chandrasekar and colleagues sought to analyze the impact of lymph node dissection at the time of nephrectomy and tumor thrombectomy on oncologic outcomes in patients with renal cell carcinoma and tumor thrombus. The records of 1978 patients from 24 centers with RCC and tumor thrombus and without evidence of systemic metastasis were included.
All patients underwent radical nephrectomy with tumor thrombectomy between 1985-2014. The primary outcome measure was 5-year cancer-specific survival (CSS) and multivariable analysis was performed to identify independent predictors of CSS.
The overall 5-year CSS was 60.9% (95% CI 58.1-63.5%). Lymphadenectomy was performed in 1026 patients and lymph node (LN) metastasis was seen in 223 (21.7%). The median number of LNs removed was 7 and patients with LN metastases had a median of 2 positive LNs. On multivariable analysis, the presence of LN metastasis, number of positive LNs, and LN density were independently associated with cancer-specific mortality.
Clinical node negative disease was documented in 573 patients and 43 (10.6%) of these patients had pathologically positive lymph nodes at surgery. Patients with clinical node negative and positive nodes at surgery demonstrated improved CSS compared to patients with clinically and pathologically positive nodes (3-year CSS 50.2% versus 33.7%, p =0.047). In multivariable analysis for patients in this subgroup, positive clinical node status was an independent predictor of cancer specific mortality (HR 2.923, p=0.015).
The authors concluded that number of positive LNs and LN density were strong prognostic indicators of better CSS. They also noted that the rate of pathologically positive LNs among clinically negative LN patients is high. Therefore, they argued that a lymphadenectomy should be routinely done in this challenging patient population.
Presented By: Thenappan Chandrasekar, MD