Lymph node (LN) involvement in renal cell carcinoma (RCC) is associated with a poor prognosis. While lymph node dissection (LND) may provide diagnostic information, its therapeutic benefit remains controversial. Thus, the aim of our study is to analyze survival outcomes after LND for nonmetastatic RCC and to characterize contemporary practice patterns.
The National Cancer Database was queried for patients with nonmetastatic RCC who underwent either partial or radical nephrectomy from 2010 to 2014. A total of 11,867 underwent surgery and LND. Chi-square tests were used to examine differences in patient demographics. To minimize selection bias, propensity score matching (PSM) was used to select one control for each LND case (n = 19,500). Cox regression analyses were conducted to examine overall survival (OS) in patients who received LND compared to those who did not.
Of all patients undergoing LND for RCC (n = 11,867), 5%, 23%, 31%, 47% were performed for tumors of clinical T stage 1, 2, 3, and 4, respectively. Proportions of LND have not significantly changed from 2010 to 2014. No significant improvement in median OS for patients undergoing LND compared to no LND was shown (34.7 vs. 34.9 months, respectively; P = 0.98). Similarly, no significant improvement in median OS was found for clinically LN positive patients undergoing LND compared to no LND (P = 0.90). On Cox regression analysis, LND dissection was not associated with an OS benefit (hazard ratio: 1.00; 95% confidence interval 0.97 to 1.04).
Among all RCC patients, LNDs are often performed for low stage disease, suggesting a potential overutilization of LND. No OS benefit was seen in any subgroup of patients undergoing LND. Further investigation is needed to determine which patient populations may benefit most from LND.
Urologic oncology. 2018 Nov 13 [Epub ahead of print]
Nicholas J Farber, Zorimar Rivera-Núñez, Sinae Kim, Brian Shinder, Kushan Radadia, Joshua Sterling, Parth K Modi, Sharad Goyal, Rahul Parikh, Tina M Mayer, Robert E Weiss, Isaac Y Kim, Sammy E Elsamra, Thomas L Jang, Eric A Singer
Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ., Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ., Division of Biometrics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ., Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ., Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ. Electronic address: .