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)

Derya Tilki, Thenappan Chandrasekar, Umberto Capitanio, Gaetano Ciancio, Siamak Daneshmand, Paolo Gontero, Javier Gonzalez, Axel Haferkamp, Markus Hohenfellner, William C. Huang, Estefania Linares Espinós, Adam Lorentz, Juan I. Martinez-Salamanca, Viraj A. Master, James M. McKiernan, Francesco Montorsi, Giacomo Novara, Sascha Pahernik, Juan Palou, Raj S. PruthiOscar Rodriguez-Faba, Paul Russo, Douglas S. Scherr, Shahrokh F. Shariat, Martin Spahn, Carlo Terrone, Cesar Vera-Donoso, Richard Zigeuner, John A. Libertino, Christopher P. Evans

Research output: Contribution to journalArticle

6 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)79.e11-79.e17
JournalUrologic Oncology: Seminars and Original Investigations
Volume36
Issue number2
DOIs
StatePublished - Feb 2018

Keywords

  • Inferior vena cava
  • Lymph node metastasis
  • Lymphadenectomy
  • Renal cell carcinoma
  • Survival
  • Vena cava tumor thrombectomy

ASJC Scopus subject areas

  • Oncology
  • Urology

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    Tilki, D., Chandrasekar, T., Capitanio, U., Ciancio, G., Daneshmand, S., Gontero, P., Gonzalez, J., Haferkamp, A., Hohenfellner, M., Huang, W. C., Linares Espinós, E., Lorentz, A., Martinez-Salamanca, J. I., Master, V. A., McKiernan, J. M., Montorsi, F., Novara, G., Pahernik, S., Palou, J., ... Evans, C. P. (2018). 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). Urologic Oncology: Seminars and Original Investigations, 36(2), 79.e11-79.e17. https://doi.org/10.1016/j.urolonc.2017.10.008