PURPOSE: Patients with locally advanced renal cell carcinoma represent a subset that may benefit from retroperitoneal lymph node dissection.
We identified preoperative clinical predictors of positive lymph nodes in patients with renal cell carcinoma without distant metastasis who underwent retroperitoneal lymph node dissection.
MATERIALS AND METHODS: We retrospectively analyzed data on a consecutive cohort of 1,270 patients with cTany Nany M0 renal cell carcinoma who were treated at a single institution from 1993 to 2012. Multivariate analysis was performed to determine preoperative predictors of pathologically positive lymph nodes in patients who underwent retroperitoneal lymph node dissection. A nomogram was developed to predict the probability of lymph node metastasis. Overall, cancer specific and recurrence-free survival was estimated using the Kaplan-Meier Method.
RESULTS: We identified 1,270 patients with renal cell carcinoma without distant metastasis who were (564) or were not (706) treated with retroperitoneal lymph node dissection. Of 564 treated patients 131 (23%) and 433 (77%) had pN1 and pN0 disease, and 60 (37%) and 29 (7.2%) had cN1pN0 and cN0pN1 disease, respectively. ECOG PS, cN stage, local symptoms and lactate dehydrogenase were associated with nodal metastasis on multivariable analysis. A nomogram was developed with a C-index of 0.89 that demonstrated excellent calibration. Differences in overall, cancer specific and recurrence-free survival among pNx, pN0 and pN1 cases were statistically significant (p < 0.001).
CONCLUSIONS: Local symptoms, ECOG PS, cN stage and lactate dehydrogenase were independent predictors of lymph node metastasis in patients who underwent retroperitoneal lymph node dissection. Our predictive nomogram using these factors showed excellent discrimination and calibration.
Written by:
Babaian KN, Kim DY, Kenney PA, Wood CG Jr, Wong J, Sanchez C, Fang JE, Gerber JA, Didic A, Wahab A, Golla V, Torres C, Tamboli P, Qiao W, Matin SF, Wood CG, Karam JA. Are you the author?
Department of Urology, University of California-Irvine, Orange, California; Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, Texas; Department of Urology Pathology, University of Texas M.D. Anderson Cancer Center, Houston, Texas; Department of Urology Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, Texas; Department of Urology, Yale School of Medicine (PAK), New Haven, Connecticut.
Reference: J Urol. 2014 Oct 25. pii: S0022-5347(14)04797-1.
doi: 10.1016/j.juro.2014.10.096
PubMed Abstract
PMID: 25390078