3 years ago

The impact of lymph node dissection and positive lymph nodes on cancer specific mortality in contemporary pT2-3 non-metastatic renal cell carcinoma treated with radical nephrectomy

Zhe Tian, Alberto Briganti, Tristan Martel, Umberto Capitanio, Marco Bandini, Anil Kapoor, Raisa S. Pompe, Luca Cindolo, Pierre I. Karakiewicz, Shahrokh F. Shariat, Michele Marchioni, Luigi Schips
Objective To assess the effect of lymph node dissection (LND), number of removed nodes (NRN) and number of positive nodes (NPN) on cancer specific mortality (CSM), in contemporary vs. historical patients, with pT2-3NanyM0 renal cell carcinoma (RCC) treated with radical nephrectomy (RN). Methods Within the SEER database (2001-2013), we identified patients with non-metastatic pT2-3 Nany RCC who underwent RN with or without LND. Kaplan–Meier analyses and multivariable Cox regression models with propensity score weighting for inverse probability of treatment were used. Results Of 25,357 patients, 24.8% underwent lymph node dissection (2001-2007: 3,167 patients vs. 2008-2013: 3,133 patients). Median NRN was 3 (IQR 1-7). Positive nodes were identified in 17.1%: 9.3% of pT2 and 21.6% of pT3 patients, who underwent LND. Median NPN was 2 (IQR 1-2). In multivariable models, LND did not decrease CSM (HR 1.29, p<0.001). LND extent, defined as NRN, did not decrease CSM (HR: 0.94, p=0.3). Finally, multivariable models testing the effect of NPN showed increased CSM, in pT3 but not in pT2 patients (HR:1.29 and 1.58, p=0.02 and 0.1, respectively). NRN exerted a protective effect on CSM in patients with positive nodes (HR:0.98; p=0.007). Conclusion In contemporary and historical patients LND or its extent, do not protect from CSM. However, the NPN increases the rate of CSM in pT3 patients. In consequence, LND and its extent appear to have little or any therapeutic value in pT2-3NanyM0 patients, besides its prognostic impact. High risk non-metastatic patients may represent a target population for a multi-institutional prospective trial. This article is protected by copyright. All rights reserved.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/bju.14024

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