Extent of lymph node dissection at nephrectomy affects cancer‐specific survival and metastatic progression in specific sub‐categories of patients with renal cell carcinoma (RCC). (22nd May 2014)

• Record Type: Journal Article
• Authors: Capitanio, Umberto; Suardi, Nazareno; Matloob, Rayan; Roscigno, Marco; Abdollah, Firas; Di Trapani, Ettore; Moschini, Marco; Gallina, Andrea; Salonia, Andrea; Briganti, Alberto; Montorsi, Francesco; Bertini, Roberto
• Is Part Of: BJU international. Volume 114:Number 2(2014:Aug.)
• Page Start: 210
• Page End: 215
• Publication Date: 2014-05-22
• Subjects: Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/bju.12508
• Languages: English
• ISSNs: 1464-4096

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bju12508-sec-0001" sec-type="section"> <title>Objective</title> <p> <list id="bju12508-list-0001" list-type="bullet"> <list-item> <p>To test whether the number of lymph nodes removed affects cancer‐specific survival (CSS) or metastatic progression‐free survival (MPFS) in different renal cell carcinoma (RCC) scenarios.</p> </list-item> </list> </p> </sec> <sec id="bju12508-sec-0002" sec-type="section"> <title>Methods</title> <p> <list id="bju12508-list-0002" list-type="bullet"> <list-item> <p>We used Cox regression analyses to analyse the effect of the number of lymph nodes removed on CSS and MPFS in 1983 patients with RCC treated with nephrectomy.</p> </list-item> <list-item> <p>To adjust for possible clinical and surgical selection bias, analyses were further adjusted for number of positive nodes, presence of metastases, age, performance status, T stage, tumour size and grade.</p> </list-item> </list> </p> </sec> <sec id="bju12508-sec-0003" sec-type="section"> <title>Results</title> <p> <list id="bju12508-list-0003" list-type="bullet"> <list-item> <p>The prevalence of lymph node invasion was 6.1%. The mean follow‐up period was 83.3 months.</p> </list-item> <list-item> <p>Multivariable analyses showed that the number of nodes removed had an independent, protective effect on CSS in patients with pT2a–pT2b or pT3c–pT4 RCC (hazard ratio [HR] 0.91, <italic>P</italic> = 0.008 and HR 0.89, <italic>P</italic> < 0.001, respectively), in patients with bulky tumours (tumour size >10 cm, HR 0.97, <italic>P</italic> = 0.03) or when sarcomatoid features were found (HR 0.81, <italic>P</italic> = 0.006).</p> </list-item> <list-item> <p>The removal of each additional lymph node was associated with a 3–19% increase in CSS.</p> </list-item> <list-item> <p>When considering MPFS as an endpoint, the number of nodes removed had an independent, protective effect in the same patient categories.</p> </list-item> </list> </p> </sec> <sec id="bju12508-sec-0004" sec-type="section"> <title>Conclusions</title> <p> <list id="bju12508-list-0004" list-type="bullet"> <list-item> <p>When clinically indicated, the number of nodes removed affects CSS and MPFS in specific sub‐categories of patients with RCC.</p> </list-item> </list> </p> </sec> </abstract>