Lymph node dissection during cytoreductive nephrectomy: a retrospective analysis.

Abstract

OBJECTIVE:

To assess whether regional lymph node dissection could improve the prognosis of patients with metastatic renal cell carcinoma.

METHODS:

We reviewed data on 258 patients who underwent cytoreductive nephrectomy at Memorial Sloan Kettering Cancer Center, New York, USA, some of whom received a concurrent lymph node dissection. The primary outcome measure was overall survival. A Cox proportional hazards regression model included, age, pathological stage, lymphadenopathy, tumor size, modified Memorial Sloan Kettering Cancer Center criteria, site of metastatic disease and lymph node dissection. We created a logistic regression model to evaluate risk factors for node-positive disease. Survival analyses were carried out 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 lymph node dissection, and positive nodes were found in 59 (33%). The 5-year overall survival was 21% for patients who underwent lymph node dissection and 31% for patients who did not. No significant difference in survival was found among patients receiving or not receiving lymph node dissection. The 5-year overall survival was 27% and 9% for negative and positive nodal status, respectively (P < 0.0005). For patients who underwent lymph node dissection, the presence of lymphadenopathy was a significant predictor of node-positive disease (odds ratio 25.0, 95% confidence interval 9.04-69.4, P < 0.0001).

CONCLUSIONS:

Lymph node dissection carried out during cytoreductive nephrectomy is not associated with a survival benefit. Lymph node-positive disease represents a poor prognostic variable; therefore, lymph node dissection should be considered as a staging procedure for clinical trials.

• Authors: Michael A Feuerstein, Matthew Kent, Melanie Bernstein, Paul Russo
• Journal: International journal of urology : official journal of the Japanese Urological Association (Int J Urol) Vol. 21 Issue 9 Pg. 874-9 (Sep 2014) ISSN: 1442-2042 [Electronic] Australia
• PMID: 24712686 (Publication Type: Evaluation Study, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: © 2014 The Japanese Urological Association.

Topics

• Aged
• Carcinoma, Renal Cell (mortality, secondary, surgery)
• Cytoreduction Surgical Procedures
• Female
• Humans
• Kidney Neoplasms (mortality, pathology, surgery)
• Lymph Node Excision
• Male
• Middle Aged
• Nephrectomy (methods)
• Prognosis
• Retrospective Studies
• Survival Rate