To characterize recurrence and survival patterns in pathologically node-positive, nonmetastatic (pN1M0) renal cell carcinoma (RCC) and identify prognostic factors.
Patients with pTanyN1M0 clear cell, papillary, or chromophobe RCC from the Canadian Kidney Cancer Information System who underwent radical or partial nephrectomy with lymph node dissection between 2011 and 2023 were included.
Recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were estimated using Kaplan-Meier methods. Prognostic factors were assessed using univariable and multivariable Cox proportional hazards models.
One hundred thirteen patients (69% male) were followed for a median of 3.1 years (IQR 1.2-6.0). Recurrence occurred in 77% (n = 87/113) at a median of 4.8 months (IQR 3.6-7.2), predominantly with distant metastases (n = 59/87). Median CSS was 5.5 years (IQR 3.8-nonestimable) and median OS was 4.4 years (IQR 3.4-6.5). On univariable analysis, pT3/T4 stage (HR 2.14, 95% CI 1.43-3.19, P < .001) and necrosis (HR 0.70, 95% CI 0.54-0.90, P = .006) were associated with RFS. Sarcomatoid differentiation was associated with CSS (HR 2.55, P = .025) and OS (HR 2.73, P = .013). On multivariable analysis, necrosis (adjusted HR 0.61, 95% CI 0.47-0.79, P < .001) and sarcomatoid differentiation (adjusted HR 2.69, 95% CI 1.01-7.21, P = .049) remained independently associated with RFS and CSS, respectively.
Patients with pN1M0 RCC experience rapid, frequent recurrences predominantly with metastatic disease, with survival outcomes resembling metastatic RCC. Restaging imaging prior to adjuvant immunotherapy initiation is essential to identify patients who may have already progressed.
Clinical genitourinary cancer. 2026 Feb 10 [Epub ahead of print]
Jesse Tr Spooner, Christopher Bitcon, Wyatt MacNevin, Ranjeeta Mallick, Rodney H Breau, Lori A Wood, Simon Tanguay, Antonio Finelli, Lucas Dean, Miles Mannas, Jasmir G Nayak, Luke T Lavallée, Jean-Baptiste Lattouf, Frédéric Pouliot, Aly-Khan A Lalani, Daniel Heng, Georg Bjarnason, Naveen Basappa, Bimal Bhindi, Camilla Tajzler, Ricardo Rendon
Department of Urology, Dalhousie University, Nova Scotia, Canada. Electronic address: ., Department of Urology, Dalhousie University, Nova Scotia, Canada., School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada., School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Division of Urology, University of Ottawa, Ottawa, Ontario, Canada., Division of Medical Oncology, QEII Health Sciences Center, Halifax, Nova Scotia, Canada., Division of Urology, McGill University, Montreal, Quebec, Canada., Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Center, University Health Network and University of Toronto, Toronto, Ontario, Canada., Department of Surgery, Alberta Urology Institute Research Center, University of Alberta, Edmonton, Alberta, Canada., Urologic Sciences, The University of British Columbia, Vancouver, British Columbia, Canada; Vancouver Prostate Centre, Vancouver, British Columbia, Canada., Section of Urology, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba Winnipeg, Manitoba, Canada; Men's Health Clinic Manitoba, Winnipeg, Manitoba, Canada., Department of Surgery, University of Montreal, Montreal, Quebec, Canada., Division of Urology, CHU of Quebec and Laval University, Quebec City, Quebec, Canada., Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada., Division of Medical Oncology, University of Calgary, Calgary, Alberta, Canada., Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada., Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada., Division of Urology, University of Calgary, Calgary, Alberta, Canada., Ri-MUHC, McGill University, Montreal, Quebec, Canada.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/41791964