Trends and outcomes of lymphadenectomy for nonmetastatic renal cell carcinoma: A propensity score-weighted analysis of the National Cancer Database

Abstract

Purpose: Lymph node (LN) involvement in renal cell carcinoma (RCC) is associated with a poor prognosis. While lymph node dissection (LND) may provide diagnostic information, its therapeutic benefit remains controversial. Thus, the aim of our study is to analyze survival outcomes after LND for non-metastatic RCC and to characterize contemporary practice patterns. Materials and Methods: The National Cancer Database was queried for patients with non−metastatic RCC who underwent either partial or radical nephrectomy from 2010−2014. A total of 11,867 underwent surgery and LND. Chi square tests were used to examine differences in patient demographics. To minimize selection bias, propensity score matching (PSM) was used to select one control for each LND case (n= 19,500). Cox regression analyses were conducted to examine overall survival (OS) in patients who received LND compared to those who did not. Results: Of all patients undergoing LND for RCC (n= 11,867), 5, 23, 31, 47% were performed for tumors of clinical T stage 1, 2, 3, and 4, respectively. Proportions of LND have not significantly changed from 2010 to 2014. No significant improvement in median OS for patients undergoing LND compared to no LND was shown (34.7 vs. 34.9 months, respectively; p = 0.98). Similarly, no significant improvement in median OS was found for clinically LN positive patients undergoing LND compared to no LND (p=0.90). On Cox regression analysis, LND dissection was not associated with an OS benefit (HR: 1.00; 95% CI 0.97–1.04). Conclusions: Among all RCC patients, LNDs are often performed for low stage disease, suggesting a potential overutilization of LND. No OS benefit was seen in any subgroup of patients undergoing LND. Further investigation is needed to determine which patient populations may benefit most from LND.

Prognostic significance of pathologic nodal positivity in non-metastatic patients with renal cell carcinoma who underwent radical or partial nephrectomy

“…Even patients staged pN0 in the LND group had significantly worse MFS than the non-LND group (designated as pNx), indicating the necessity of indications for LN dissection during radical/ partial nephrectomy in RCC. A recent study from Raddia et al supported our findings, and they suggested that the thorough clinical staging with preoperative imaging studies was an important factor for identifying the high-risk LN+ group and providing the beneficiary role of LND in the survival outcomes of nmRCC patients who underwent curative nephrectomy 20,21 . In these backgrounds, a recent adjuvant clinical trial suggesting several eligibility and radiologic assessments for kidney cancer that either CT or MRI within 4 weeks should be performed, and every patient with microscopically positive soft tissue or vascular margins without gross residual or radiologic disease may be included in trials to all suspicious regional lymph nodes 22 .…”

The Role of Lymph Node Dissection for Non-Metastatic Renal Cell Carcinoma: An Updated Systematic Review and Meta-Analysis

“…The article of Farber et al. included a database from NCDB (2010-2014) with a sample size of 19,500 patients ( 10 ). While the database of Bacic et al.…”

Impact of pathologic lymph node‐positive renal cell carcinoma on survival in patients without metastasis: Evidence in support of expanding the definition of stage IV kidney cancer

“…Furthermore, the results of recent retrospective studies have suggested that the more precise selection of high‐risk patients may better elucidate the advantages to LND. Patients with high‐risk features, larger tumors, and LN involvement may represent an important, but difficult to isolate, population of patients who may derive the most benefit from LND 5,10,14,20 . In addition, new data have demonstrated that increased LN disease burden, even among those patients with pN+ pathology, correlates with inferior overall survival.…”

“…It derives its data from approximately 1500 accredited hospitals. Information regarding patient demographics, cancer staging, tumor characteristics, surgical treatment, and patient prognosis is recorded 9,10 …”