AUA 2013 - Session Highlights: Concordance between clinical and pathological lymph node invasion in renal cell carcinoma

SAN DIEGO, CA USA (UroToday.com) - Harnessing available information during evaluation and staging may significantly affect patient counseling as well as pre-operative and intra-operative treatment planning.

Clinically enlarged lymph nodes on pre-operative imaging may carry significant prognostic information, but the false-positive rate of this radiographic finding is poorly characterized.

auaDr. Umberto Capitanio and colleagues reviewed 1 983 patients with renal cell carcinoma (RCC) undergoing extirpative treatment at a single institution and identified 256 (12.9%) with at least one clinically enlarged lymph node on pre-operative cross-sectional imaging. Of these, 89 (34.8%) were confirmed to have involved lymph nodes on pathologic evaluation. Stratified by clinical stage, clinical vs pathologically confirmed nodes were present in 75.4 vs 24.4 % in T1, 64.7 vs 35.3% in T2, 55.8 vs 44.2% in T3 and 50.0 vs 50.0% in T4, respectively (p < 0.001). The investigators also found that presence or absence of metastasis at the time of surgery corresponded to 45.7% vs 27.2% pathologically involved nodes, respectively (p=0.001). Multivariable analysis identified tumor size to be significantly associated with pathologically proven lymph node invasion in patients with radiographic lymphadenopathy (OR 1.14, p=0.001).

In summary, radiographic lymphadenopathy should be interpreted with caution. Up to 60% of patients may exhibit falsely positive radiographic lymphadenopathy, with tumor size as the most influential independent predictor of pathologic lymph node involvement.

Presented by Umberto Capitanio, Rayan Matloob, Fabio Castiglione, Paolo Capogrosso, Andrea Russo, Cristina Carenzi, La Croce Giovanni, Paolo Dell'Oglio, Andrea Gallina, Alberto Briganti, Francesco Montorsi, and Roberto Bertini at the American Urological Association (AUA) Annual Meeting - May 4 - 8, 2013 - San Diego Convention Center - San Diego, California USA

Reported for UroToday.com by Serge Ginzburg, MD

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