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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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

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Lymph Node Excision
Renal Cell Carcinoma
Survival
Nephrectomy
Confidence Intervals
Neoplasms
Lymph Nodes
Therapeutics
Dissection
Multivariate Analysis
Clinical Trials
Prospective Studies

All Science Journal Classification (ASJC) codes

  • Oncology
  • Urology

Cite this

Chipollini, Juan ; Abel, E. Jason ; Peyton, Charles C. ; Boulware, David C. ; Karam, Jose A. ; Margulis, Vitaly ; Master, Viraj A. ; Zargar-Shoshtari, Kamran ; Matin, Surena F. ; Sexton, Wade J. ; Raman, Jay ; Wood, Christopher G. ; Spiess, Philippe E. / Pathologic Predictors of Survival During Lymph Node Dissection for Metastatic Renal-Cell Carcinoma : Results From a Multicenter Collaboration. In: Clinical Genitourinary Cancer. 2018 ; Vol. 16, No. 2. pp. e443-e450.
@article{3170f78f85104f2193e51691ed33e275,
title = "Pathologic Predictors of Survival During Lymph Node Dissection for Metastatic Renal-Cell Carcinoma: Results From a Multicenter Collaboration",
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.",
author = "Juan Chipollini and Abel, {E. Jason} and Peyton, {Charles C.} and Boulware, {David C.} and Karam, {Jose A.} and Vitaly Margulis and Master, {Viraj A.} and Kamran Zargar-Shoshtari and Matin, {Surena F.} and Sexton, {Wade J.} and Jay Raman and Wood, {Christopher G.} and Spiess, {Philippe E.}",
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Chipollini, J, Abel, EJ, Peyton, CC, Boulware, DC, Karam, JA, Margulis, V, Master, VA, Zargar-Shoshtari, K, Matin, SF, Sexton, WJ, Raman, J, Wood, CG & Spiess, PE 2018, 'Pathologic Predictors of Survival During Lymph Node Dissection for Metastatic Renal-Cell Carcinoma: Results From a Multicenter Collaboration', Clinical Genitourinary Cancer, vol. 16, no. 2, pp. e443-e450. https://doi.org/10.1016/j.clgc.2017.10.004

Pathologic Predictors of Survival During Lymph Node Dissection for Metastatic Renal-Cell Carcinoma : Results From a Multicenter Collaboration. / Chipollini, Juan; Abel, E. Jason; Peyton, Charles C.; Boulware, David C.; Karam, Jose A.; Margulis, Vitaly; Master, Viraj A.; Zargar-Shoshtari, Kamran; Matin, Surena F.; Sexton, Wade J.; Raman, Jay; Wood, Christopher G.; Spiess, Philippe E.

In: Clinical Genitourinary Cancer, Vol. 16, No. 2, 01.04.2018, p. e443-e450.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Pathologic Predictors of Survival During Lymph Node Dissection for Metastatic Renal-Cell Carcinoma

T2 - Results From a Multicenter Collaboration

AU - Chipollini, Juan

AU - Abel, E. Jason

AU - Peyton, Charles C.

AU - Boulware, David C.

AU - Karam, Jose A.

AU - Margulis, Vitaly

AU - Master, Viraj A.

AU - Zargar-Shoshtari, Kamran

AU - Matin, Surena F.

AU - Sexton, Wade J.

AU - Raman, Jay

AU - Wood, Christopher G.

AU - Spiess, Philippe E.

PY - 2018/4/1

Y1 - 2018/4/1

N2 - 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.

AB - 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.

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