Renal cell carcinoma with retroperitoneal lymph nodes

Abstract

BACKGROUNDThe current study was performed to determine the impact of the presence of retroperitoneal lymphadenopathy on the survival and response to immunotherapy of patients with metastatic renal cell carcinoma (RCC).METHODSA retrospective cohort study was performed with outcome assessment based on the chart review of demographic, clinical, and pathologic data from 1087 patients. Patients with RCC who did not present with metastatic disease, who did not undergo nephrectomy as part of their cancer treatment, and those in whom either the lymph node (N) or metastatic (M) status was unknown, were excluded. A total of 322 M1 patients who met these criteria and who underwent nephrectomy for unilateral RCC formed the principal study population.RESULTSTwo hundred thirty‐six patients presented with N0M1 disease and 86 patients presented with N+M1 disease. In M1 patients, the presence of positive regional lymph nodes was associated with larger sized, higher grade, locally advanced primary tumors that were more commonly associated with sarcomatoid features. N0M1 patients were more likely to achieve an objective response to systemic immunotherapy compared with N+M1 patients (P = 0.01). N+M1 patients overall had worse short‐term and long‐term survival compared with N0M1 patients, with a median survival of 10.5 months compared with 20.4 months, respectively. The median survival of N0M1 patients was improved to 28 months in those who received adjunctive immunotherapy (P = 0.0008), whereas the median survival of patients with N+M1 disease was the same in those treated with and those treated without adjunctive immunotherapy (P = 0.18).CONCLUSIONSEven in the modern era of systemic immunotherapy, the presence of regional lymphadenopathy exerts a detrimental effect on the survival of patients with metastatic RCC. Lymph node status is a strong predictor of the failure to achieve either an objective immunotherapy response or an improvement in survival when immunotherapy is given as an adjunctive treatment after cytoreductive nephrectomy. However, in multivariate analysis, including both clinical and pathologic variables, lymph node status was found to have less of an impact on survival than primary tumor stage and grade and patient performance status. Cancer 2003;97:2995–3002. © 2003 American Cancer Society.DOI 10.1002/cncr.11422

The role of lymphadenectomy in renal cell carcinoma

“…Pantuck et al [7] at the UCLA showed the impact of lymph node-positive disease on a large cohort of metastatic patients (322 M1 patients) treated with nephrectomy. In this study, 236 patients with pathologic N0M1 RCC were compared with 86 patients with pathologic NþM1, and outcomes following systemic immunotherapy were analyzed.…”

“…The 5-year survival of patients with lymph node-only metastasis ranges from 5 to 40% [3,7,[18][19][20]. Prospective assessment of a patient's risk of occult lymph node metastasis would assist surgeons in planning for lymphadenectomy and at the very least improve staging over omitting lymphadenectomy [19,20].…”

Lymphknotendissektion beim Nierenzellkarzinom

“…Pantuck et al [10] fan den bei 2 von 385 Pa ti enten ohne Lymph kno ten dis sek ti on im weidig lich bei 3 der Fäl le wer den bei CT-nega ti vem Lymph kno tens ta ging in der histo lo gi schen Un ter su chung Me tas ta sen gefun den [2,9]. Um ge kehrt er wei sen sich im CT auf fäl li ge Lymph kno ten in bis zu 58 als falsch-po si ti ve Be fun de [14].…”

“…Die 5-Jah res-Über lebens ra ten be tra gen für pN0-Pa ti en ten ca. 75, die der pN+-Pa ti en ten 20 [10].…”

“…Pantuck et al [10] ha ben re tro spek tiv ge prüft, ob der Er folg ei ner Im mun the ra pie beim me ta sta sier ten Nie ren zellkar zi nom vom Lymph kno ten sta tus ab hängt. Wäh rend bei lymph kno ten po si ti ven Pa ti en ten die Im mun the ra pie kei ne Pro gno se ver bes serung er ziel te, hat te sie in der Grup pe der pN0M+-Pa ti en ten eine sig ni fi kan te Lebens ver län ge rung zur Fol ge.…”