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Development and external validation of a pathological nodal staging score for patients with clear cell renal cell carcinoma

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Abstract

Objectives

To develop and externally validate a model that quantifies the likelihood that a pathologically node-negative patient with clear cell renal cell carcinoma (cRCC) has, indeed, no lymph node metastasis (LNM).

Patients and methods

Data from 1389 patients treated with radical nephrectomy (RN) and lymph node dissection (LND) were analyzed. For external validation, we used data from 2270 patients in the Surveillance, Epidemiology and End Results (SEER) database. We estimated the sensitivity of pathologic nodal staging using a beta-binomial model and developed a pathological nodal staging score (pNSS), which represents the probability that a patient is correctly staged as node negative as a function of the number of examined lymph nodes (LNs).

Results

The mean and median number of LNs removed were 7.0 and 5.0 (standard deviation, SD 6.6; interquartile range, IQR 7.0) in the development cohort and 5.6 and 2.0 (SD 8.6, IQR 5.0) in the validation cohort, respectively. The probability of missing a positive LN decreased with increasing number of LNs examined. In both the validation and the development cohort, the number of LNs needed for correctly staging a patient as node negative increased with higher pathological tumor stage and Fuhrman grade.

Conclusions

The number of examined LNs needed for adequate nodal staging in cRCC depends on pathological tumor stage and Fuhrman grade. We developed here and then externally validated a pNSS, which could help to refine patient counseling, decision-making regarding risk-stratified surveillance regimens and inclusion criteria for clinical trials of adjuvant therapy.

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Authors and Affiliations

  1. Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria

    Malte Rieken, Mohammad Abufaraj, Beat Foerster & Shahrokh F. Shariat

  2. Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA

    Malte Rieken, Luis A. Kluth, Morgan Rouprêt & Shahrokh F. Shariat

  3. Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN, USA

    Stephen A. Boorjian, R. Houston Thompson & Bradley C. Leibovich

  4. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Luis A. Kluth

  5. Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy

    Umberto Capitanio & Alberto Briganti

  6. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Laura-Maria Krabbe, Vitaly Margulis & Shahrokh F. Shariat

  7. Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA

    Jay D. Raman & Mikhail Regelman

  8. Department of Urology, University of Montreal, Montreal, QC, Canada

    Pierre I. Karakiewicz

  9. Department of Urology, Pitié-Salpétrière, Assistance-Publique Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France

    Morgan Rouprêt

  10. Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan

    Mohammad Abufaraj

  11. Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland

    Beat Foerster

  12. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Mithat Gönen

  13. Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria

    Shahrokh F. Shariat

  14. University of Basel, Basel, Switzerland

    Malte Rieken

Authors
  1. Malte Rieken
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  2. Stephen A. Boorjian
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  3. Luis A. Kluth
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  4. Umberto Capitanio
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  5. Alberto Briganti
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  6. R. Houston Thompson
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  7. Bradley C. Leibovich
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  8. Laura-Maria Krabbe
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  9. Vitaly Margulis
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  10. Jay D. Raman
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  11. Mikhail Regelman
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  12. Pierre I. Karakiewicz
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  13. Morgan Rouprêt
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  14. Mohammad Abufaraj
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  15. Beat Foerster
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  16. Mithat Gönen
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  17. Shahrokh F. Shariat
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Contributions

MR contributed to data collection, management and analysis, protocol development and manuscript writing and editing. SAB helped in protocol development, data collection, and manuscript editing. LAK performed protocol development, data collection and management, and manuscript editing. RHT, BCL, L-MK, VM, BF, PIK, MR and JDR performed data collection and manuscript editing. UC, AB and MR contributed to manuscript editing. MG and MA helped in data collection and management, and manuscript editing. SFS helped in project and protocol development, data collection and analysis, and manuscript writing and editing.

Corresponding author

Correspondence to Shahrokh F. Shariat.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Institutional review board approval was obtained by all participating centers and provided institutional data sharing agreements in accordance with the ethical standards of the institutional and/or national research committee.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Rieken, M., Boorjian, S.A., Kluth, L.A. et al. Development and external validation of a pathological nodal staging score for patients with clear cell renal cell carcinoma. World J Urol 37, 1631–1637 (2019). https://doi.org/10.1007/s00345-018-2555-5

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  • DOI: https://doi.org/10.1007/s00345-018-2555-5

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