Radical Nephrectomy With or Without Lymph Node Dissection for High-Risk Non-Metastatic Renal Cell Carcinoma: A Multi-Institutional Analysis

LND may benefit patients at increased risk of lymph node (LN) metastases from renal cell carcinoma (RCC). We therefore evaluated the association of LND with survival among high-risk patients undergoing radical nephrectomy (RN) for RCC.

We identified 2,722 patients with M0 RCC who underwent RN with or without LND at two international centers from 1990-2010. The associations of LND with development of distant metastases, cancer-specific mortality (CSM), and all-cause mortality (ACM) were evaluated using propensity score techniques and traditional multivariable Cox regression. Subset analyses examined patients at increased risk of LN metastases.

Overall, 171 (6.3%) patients were pN1. Median follow-up was 9.6 years. Clinicopathologic features were well balanced after PS adjustment. LND was not significantly associated with a reduced risk of distant metastases, CSM, or ACM in the overall cohort, among patients with preoperative radiographic lymphadenopathy (cN1), or across increasing probability of pN1 disease from ≥0.10 to ≥0.50. Neither performance of extended LND nor the extent of LND was associated with improved oncologic outcomes.

The current analysis of a large, international cohort indicates that LND is not associated with improved oncologic outcomes among high-risk patients undergoing RN for M0 RCC, including those with radiographic lymphadenopathy (cN1) or across increasing probability thresholds for pN1 disease.

The Journal of urology. 2017 Dec 07 [Epub ahead of print]

Boris Gershman, R Houston Thompson, Stephen A Boorjian, Alessandro Larcher, Umberto Capitanio, Francesco Montorsi, Cristina Carenzi, Roberto Bertini, Alberto Briganti, Christine M Lohse, John C Cheville, Bradley C Leibovich

Division of Urology, Rhode Island Hospital and The Miriam Hospital, Providence, RI, USA. Electronic address: ., Department of Urology, Mayo Clinic, Rochester, MN, USA., Department of Urology, San Raffaele Scientific Institute, Milan, Italy., Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA., Department of Pathology, Mayo Clinic, Rochester, MN, USA.