Lymph node dissection during cytoreductive nephrectomy: A retrospective analysis

Abstract

Objective To assess whether regional lymph node dissection (LND) could improve the prognosis of patients with metastatic renal cell carcinoma (RCC). Methods We reviewed data on 258 patients who underwent cytoreductive nephrectomy at our institution, some of whom received a concurrent LND. Primary outcome measure was overall survival. A Cox proportional hazards regression model included, age, pathologic stage, lymphadenopathy, tumor size, modified MSKCC criteria, site of metastatic disease, and LND. We created a logistic regression model to evaluate risk factors for node-positive disease. Survival analyses were performed 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 LND, and positive nodes were found in 59 (33%). Five-year overall survival was 21% for patients who underwent LND and 31% for patients who did not. We found no significant difference in survival among patients receiving or not receiving LND. Five-year overall survival was 27% and 9% for negative and positive nodal status, respectively (p <0.0005). For patients who underwent LND, the presence of lymphadenopathy was a significant predictor of node-positive disease (odds ratio 25.0, 95% CI 9.04–69.4, p <0.0001). Conclusions LND performed during cytoreductive nephrectomy was not associated with a survival benefit. Lymph node–positive disease was identified as a poor prognostic variable; therefore, LND should be considered as a staging procedure for clinical trials.

The role of lymph node dissection in the management of renal cell carcinoma: a systematic review and meta‐analysis

“…). The number of studies included for each specific aim are as follows: PA1/PA2: nine reports representing eight unique studies []; SA1: six studies (of which two represented separate analyses of the same dataset) ; SA2: 15 studies (of which one single‐institutional study was included in a multi‐institutional study) ; SA3: five studies ; SA4: 10 studies ; and SA5: 18 studies .…”

“…Moreover, in a subset of patients with clinically isolated N1M0 disease, durable long‐term survival has been observed after surgical resection of lymph node (LN) metastases . However, in the only randomized trial on the topic, European Organization for Research and Treatment of Cancer (EORTC) 30881, LND was not associated with oncological outcomes , and several modern observational studies have likewise failed to demonstrate a survival benefit with LND, in both non‐metastatic and metastatic settings .…”

Mortality trends and the impact of lymphadenectomy on survival for renal cell carcinoma patients with distant metastasis

“…12 However, a more recent mRCC cohort of 258 patients from Memorial Sloan Kettering indicated LND did not provide a survival advantage, with a comparative five-year survival of 21% for patients undergoing CN with LND and 31% for patients undergoing CN without LND. 10 Although survival was lower for patients undergoing LND, the difference was not significant due to small sample size. Furthermore, cause of death was not specified to separate deaths due to cancer from other causes.…”

“…1A shows LND over time defined as the removal of ≥3 and ≥8 LNs based on previous research. 10 Using the strictest definition (≥8), the performance of LND increased from about 2.3% in 1990 to about 5% in recent years. The mean number of LNs was 6.2 (7.9) for surgeries with at least one LN removed, and there was an average of 3.3 (4.3) positive LNs among the 1018 patients with positive nodes (Appendix B).…”

“…Relative survival was assessed using multivariable Cox proportional hazards models, along with sensitivity analyses restricting the cohort to CN patients and specific time periods. Sensitivity analyses also varied cutoffs for the number of LNs removed, defined as LND (directly reported are ≥1, ≥3, and ≥8 based on a prior study 10 ) given that the removal of one or very few LNs could indicate a LN biopsy rather than attempt at formal LND. The final relative survival estimates employed competing risks regression considering non-cancer causes of death (other-cause mortality) as a competing risk of death.…”