Pathologic Predictors of Survival During Lymph Node Dissection for Metastatic Renal-Cell Carcinoma: Results From a Multicenter Collaboration

To determine the therapeutic value of lymph node dissection (LND) during cytoreductive nephrectomy (CN) and assess predictors of cancer-specific survival (CSS) in metastatic renal-cell carcinoma.

We identified 293 consecutive patients treated with CN at 4 academic institutions from March 2000 to May 2015. LND was performed in 187 patients (63.8%). CSS was estimated by the Kaplan-Meier method for the entire cohort and for a propensity score-matched cohort. Cox proportional hazards regression was used to evaluate CSS in a multivariate model and in an inverse probability weighting-adjusted model for patients who underwent dissection.

Median follow-up was 12.6 months (interquartile range, 4.47, 30.3), and median survival was 15.9 months. Of the 293 patients, 187 (63.8%) underwent LND. One hundred six patients had nodal involvement (pN+) with a median CSS of 11.3 months (95% confidence interval [CI], 6.6, 15.9) versus 24.2 months (95% confidence interval, 14.1, 34.3) for pN- patients (log-rank P = .002). The hazard ratio for LND was 1.325 (95% CI, 1.002, 1.75) for the whole cohort and 1.024 (95% CI, 0.682, 1.537) in the propensity score-matched cohort. Multivariate analysis revealed that number of positive lymph nodes (P < .001) was a significant predictor of worse CSS.

For patients with metastatic renal-cell carcinoma undergoing CN with lymphadenectomy, the number of nodes positive was predictive of survival at short-term follow-up. However, nonstandardized lymphadenectomy only provided prognostic information without therapeutic benefit. Prospective studies with standardized templates are required to further ascertain the therapeutic value of LND.

Clinical genitourinary cancer. 2017 Oct 17 [Epub ahead of print]

Juan Chipollini, E Jason Abel, Charles C Peyton, David C Boulware, Jose A Karam, Vitaly Margulis, Viraj A Master, Kamran Zargar-Shoshtari, Surena F Matin, Wade J Sexton, Jay D Raman, Christopher G Wood, Philippe E Spiess

Moffitt Cancer Center, Tampa, FL. Electronic address: ., University of Wisconsin School of Medicine and Public Health, Madison, WI., Moffitt Cancer Center, Tampa, FL., University of Texas MD Anderson Cancer Center, Houston, TX., University of Texas Southwestern Medical Center, Dallas, TX., Emory Clinic, Atlanta, GA., Auckland City Hospital, Auckland, Australia., Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, PA.