Lymph Node Dissection Is Not Associated with Improved Survival Among Patients Undergoing Cytoreductive Nephrectomy for Metastatic Renal Cell Carcinoma: A Propensity-Score Based Analysis

The oncologic benefit of lymph node dissection (LND) for patients undergoing cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma (mRCC) is uncertain. We evaluated the association of LND with oncologic outcomes among patients undergoing CN.

We identified 305 patients treated with CN for mRCC between 1990 and 2010, of whom 188 (62%) underwent LND. Several propensity-score techniques were used to evaluate cancer-specific (CSM) and all-cause mortality (ACM). Internally predicted probabilities for pN1 disease were estimated using logistic regression.

Overall, 74 (24%) patients were pN1, and median follow-up was 8.5 years (IQR 5.6-10.7). After PS adjustment, there were no significant differences in clinicopathologic features according to receipt of LND. In the overall cohort, LND was not significantly associated with CSM or ACM using any of the PS techniques. Moreover, LND was not associated with survival outcomes among patients at increased risk of pN1 disease, including patients with preoperative radiographic lymphadenopathy (cN1), or across increasing probability thresholds for pN1 disease from 0.20 to 0.80. Nodal metastases were associated with more aggressive primary tumor features and significantly shorter cancer-specific survival.

Among patients undergoing CN for mRCC, LND was not associated with improved oncologic outcomes in the overall cohort, for patients with preoperative radiographic lymphadenopathy, or across increasing probability thresholds for pN1 disease. These findings suggest that LND at the time of CN does not confer an oncologic benefit by cytoreduction of nodal metastases. The presence of nodal metastases is associated with more aggressive tumor biology.

The Journal of urology. 2016 Sep 20 [Epub ahead of print]

Boris Gershman, R Houston Thompson, Daniel M Moreira, Stephen A Boorjian, Christine M Lohse, Brian A Costello, John C Cheville, Bradley C Leibovich

Division of Urology, Rhode Island Hospital and The Miriam Hospital, Providence, RI., Department of Urology, Mayo Clinic, Rochester, Minnesota., Department of Urology, University of Illinois, Chicago, IL., Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota., Department of Oncology, Mayo Clinic, Rochester, Minnesota., Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota., Department of Urology, Mayo Clinic, Rochester, Minnesota. Electronic address: .

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