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| Urologic oncology. 2017 Nov 9. pii: S1078-1439(17)30543-4. doi: 10.1016/j.urolonc.2017.10.008 |
| Impact of lymph node dissection at the time of radical nephrectomy with tumor thrombectomy on oncological outcomes: Results from the International Renal Cell Carcinoma-Venous Thrombus Consortium (IRCC-VTC). |
| Tilki D1, Chandrasekar T2, Capitanio U3, Ciancio G4, Daneshmand S5, Gontero P6, Gonzalez J7, Haferkamp A8, Hohenfellner M9, Huang WC10, Linares Espinós E11, Lorentz A12, Martinez-Salamanca JI13, Master VA14, McKiernan JM15, Montorsi F16, Novara G17, Pahernik S18, Palou J19, Pruthi RS20, Rodriguez-Faba O21, Russo P22, Scherr DS23, Shariat SF24, Spahn M25, Terrone C26, Vera-Donoso C27, Zigeuner R28, Libertino JA29, Evans CP30 |
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Abstract OBJECTIVES: To study the effect of lymph node dissection (LND) at the time of nephrectomy and tumor thrombectomy on oncological outcomes in patients with renal cell carcinoma (RCC) and tumor thrombus. PATIENTS AND METHODS: The records of 1,978 patients with RCC and tumor thrombus who underwent radical nephrectomy and tumor thrombectomy from 1985 to 2014 at 24 centers were analyzed. None of the patients had distant metastases. Extent and pathologic results of LND were compared with respect to cancer-specific survival (CSS). Multivariable Cox regression models were used to quantify the effect of multiple covariates. RESULTS: LND was performed in 1,026 patients. In multivariable analysis, the presence of LN metastasis, the number of positive LNs, and LN density were independently associated with cancer-specific mortality (CSM). Clinical node-negative (cN-) disease was documented in 573 patients, 447 of them underwent LND with 43 cN- patients (9.6%) revealing positive LNs at pathology. LN positive cN- patients showed significantly better CSS when compared to LN positive cN+ patients. In multivariable analysis, positive cN status in LN positive patients was a significant predictor of CSM (HR, 2.923; P = 0.015). CONCLUSIONS: The number of positive nodes harvested during LND and LN density was strong prognostic indicators of CSS, while number of removed LNs did not have a significant effect on CSS. The rate of pN1 patients among clinically node-negative patients was relatively high, and LND in these patients suggested a survival benefit. However, only a randomized trial can determine the absolute benefit of LND in this setting. |
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Copyright © 2017 Elsevier Inc. All rights reserved. |
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KEYWORDS: Inferior vena cava, Lymph node metastasis, Lymphadenectomy, Renal cell carcinoma, Survival, Vena cava tumor thrombectomy |
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Publikations ID: 29129353 Quelle: öffnen |
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