AUA 2017: The Effect of Anatomic Location of Retroperitoneal Lymph Node Metastases on Cancer-Specific Survival in Patients with Clear Cell Carcinoma
The authors performed a retrospective review of 415 patients who underwent radical nephrectomy with extended lymph node dissection (hilar, regional ipsilateral, and interaortocaval) at two tertiary referral centers in Italy.
Assessing node location in patients presenting with one positive node, researchers noted that 54% were in the ipsilateral nodal region and 26% in the interaortocaval region, which was different from individuals presenting with two or more positive lymph nodes, in which 56% of the nodal metastasis were observed in the interaortocaval area. With regard to tumor location, there was variation in the nodal distribution between right-sided and left-sided tumors. In right-sided tumors, 40% of positive nodes were discovered in the interaortocaval area and 44% in the ipsilateral lymph node packet. On the left side, 67% of positive nodes were seen in the ipsilateral lymph node packet, with only 9% found in the interaortocaval area. The laterality pattern becomes less heterogeneous in patients with two more positive lymph nodes, with 91% of nodal metastases located in the ipsilateral packet on the left side and 87% located in the interaortocaval area on right-sided tumors.
On survival analysis, the number of nodal metastases was not associated with worse cancer-specific survival. Concerning location, harboring nodal metastasis in the interaortocaval vicinity was associated with a worse cancer-specific survival odds ratio of 1.8 (1.0-3.2).
In conclusion, the data show there is no clear nodal spread pattern associated with renal cell carcinoma. Nodal metastasis located in the interaortocaval appears to be associated with worsening cancer-specific survival. While the study is provocative, it does have limitations that are mostly related to its retrospective nature and small sample size. This is clear in the assessment nodal location where nodal distribution changed significantly in patients presenting with a higher positive node burden. If the study is taken at its word, it seems to make the assessment that right-sided tumors appear to be more aggressive than left-sided tumors, given the higher propensity for having interaortocaval node involvement. Finally, the study does not help with clinical assessment as the analysis is based on patient’s pathologic nodal status and not clinical nodal status. In the future, studies assessing clinical nodal location would be helpful in further answering this question.
Presented by: Alessandro Nini, MD, University of San Rafael, Italy
Written By: Andres F. Correa, MD, Society of Urologic Oncology Fellow, Fox Chase Cancer Center, Philadelphia, PA
at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA