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

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 Raman, Christopher G. Wood, Philippe E. Spiess

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3 Scopus citations

Abstract

We report clinical outcomes using multi-institutional data to evaluate oncologic efficacy of lymph node dissection (LND) at the time of cytoreductive nephrectomy. Number of positive lymph nodes was an independent predictor for cancer-specific survival. The performance of lymphadenectomy with standard templates in clinical trials of new systemic therapies could further ascertain prognostic value of LND. Purpose: 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. Patients and Methods: 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. Results: 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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)e443-e450
JournalClinical Genitourinary Cancer
Volume16
Issue number2
DOIs
StatePublished - Apr 1 2018

All Science Journal Classification (ASJC) codes

  • Oncology
  • Urology

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    Chipollini, J., Abel, E. J., Peyton, C. C., Boulware, D. C., Karam, J. A., Margulis, V., Master, V. A., Zargar-Shoshtari, K., Matin, S. F., Sexton, W. J., Raman, J., Wood, C. G., & Spiess, P. E. (2018). Pathologic Predictors of Survival During Lymph Node Dissection for Metastatic Renal-Cell Carcinoma: Results From a Multicenter Collaboration. Clinical Genitourinary Cancer, 16(2), e443-e450. https://doi.org/10.1016/j.clgc.2017.10.004