OBJECTIVE: To assess whether regional lymph node dissection could improve the prognosis of patients with metastatic renal cell carcinoma.
METHODS: We reviewed data on 258 patients who underwent cytoreductive nephrectomy at Memorial Sloan Kettering Cancer Center, New York, USA, some of whom received a concurrent lymph node dissection. The primary outcome measure was overall survival. A Cox proportional hazards regression model included, age, pathological stage, lymphadenopathy, tumor size, modified Memorial Sloan Kettering Cancer Center criteria, site of metastatic disease and lymph node dissection. We created a logistic regression model to evaluate risk factors for node-positive disease. Survival analyses were carried out for lymph node template (hilar vs other) and number of nodes removed (0-3, 4-7 or ≥8).
RESULTS: Of 258 patients, 177 (69%) underwent lymph node dissection, and positive nodes were found in 59 (33%). The 5-year overall survival was 21% for patients who underwent lymph node dissection and 31% for patients who did not. No significant difference in survival was found among patients receiving or not receiving lymph node dissection. The 5-year overall survival was 27% and 9% for negative and positive nodal status, respectively (P < 0.0005). For patients who underwent lymph node dissection, the presence of lymphadenopathy was a significant predictor of node-positive disease (odds ratio 25.0, 95% confidence interval 9.04-69.4, P < 0.0001).
CONCLUSIONS: Lymph node dissection carried out during cytoreductive nephrectomy is not associated with a survival benefit. Lymph node-positive disease represents a poor prognostic variable; therefore, lymph node dissection should be considered as a staging procedure for clinical trials.
Written by:
Feuerstein MA, Kent M, Bernstein M, Russo P. Are you the author?
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Reference: Int J Urol. 2014 Apr 8. Epub ahead of print.
doi: 10.1111/iju.12457
PubMed Abstract
PMID: 24712686
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