Abstract | BACKGROUND: MATERIALS AND METHODS: We identified 730 patients with nonmetastatic RCC treated with nephrectomy and LND at a single center. We compared the accuracy and clinical usefulness of a base model including factors defining high-risk patients according to the S-TRAC trial [(pT3 and Grade≥2 and performance status score ≥1) or pT4] relative to the base model plus pN stage for the prediction of early progression after surgery. RESULTS: LN invasion resulted the most informative predictor of early progression (odds ratio: 6.39; 95% confidence interval [CI]: 3.26, 12.54; P < 0.0001). The accuracy was higher (P = 0.008) for the model implemented with pN (area under the curve: 0.76; 95% CI: 0.71, 0.80) as compared to the base model (area under the curve: 0.72; 95% CI: 0.68, 0.76). Performing LND to select patients for postoperative systemic treatment, resulted in a slightly higher net benefit as compared to a strategy defining risk on the base of factors other than pN. Patients with high-risk disease showed a large difference in the risk of progression according to pN-status (1-year risk: 58% [95% CI: 45, 72] for pN1; 31% [95% CI: 25, 38] for pN0; P < 0.001). CONCLUSIONS: Performing LND at the time of nephrectomy improves risk stratification, resulting into a small but nonnegligible clinical advantage for selecting high-risk patients for further treatment after surgery. Further trials should investigate whether high-risk pN1 patients would benefit from a different postoperative management.
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Authors | Paolo Capogrosso, Alessandro Larcher, Alessandro Nini, Fabio Muttin, Francesco Cianflone, Francesco Ripa, Alberto Briganti, Andrea Necchi, Francesco Montorsi, Andrea Salonia, Roberto Bertini, Umberto Capitanio |
Journal | Urologic oncology
(Urol Oncol)
Vol. 37
Issue 4
Pg. 293.e25-293.e30
(04 2019)
ISSN: 1873-2496 [Electronic] United States |
PMID | 30704958
(Publication Type: Journal Article)
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Copyright | Copyright © 2019 Elsevier Inc. All rights reserved. |
Topics |
- Carcinoma, Renal Cell
(drug therapy, pathology, surgery)
- Female
- Humans
- Lymph Node Excision
(methods)
- Male
- Middle Aged
- Nephrectomy
(methods)
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