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Valuation of lymph node dissection in localized high-risk renal cell cancer using X-tile software

Abstract

Purpose

Attempt to group the number of lymph nodes in a more ideal way to assess the value of lymph node dissection (LND) in the treatment of localized high-risk renal cell cancer (LH-RCC).

Methods

The Surveillance, Epidemiology, and End Result database (SEER) was used to analyze LH-RCC patients who undergoing radical nephrectomy (RN) from 2011 to 2015. The X-tile software was performed to calculate the optimal grouping cut-off points for the number of removed lymph nodes and positive lymph nodes. The Nomogram model was constructed by R language to visually present survival rates of patients.

Results

Among 4917 cases of LH-RCC patients undergoing RN, there were 1835 patients treated with LND (37.32%) with the average survival time (AST) of 43.10 months (95% CI 41.91–44.29), which was superior than 40.52 months of patients who did not have LND (95% CI 39.26–41.78) (P < 0.01). The mortality risk of patients with ≥ 3 removed nodes was 0.75 times that of patients with 1–2 removed nodes (95% CI 0.62–0.99, P < 0.01). For overall survival (OS), the hazard ratio of ≥ 5 positive nodes, 1–4 positive nodes, and 0 positive node was 3.04, 2.37, and 1.00, respectively. The Nomogram model can evaluate the 1 year, 2 year, and 3 year survival rates of LH-RCC patients undergoing RN with the internal validation C-index of 0.73.

Conclusion

LH-RCC patients with ≥ 3 removed lymph nodes and fewer positive lymph nodes are expected to have better long-term survival. LND is not only helpful for tumor staging of LH-RCC, but also valuable for long-term survival.

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Acknowledgements

The authors would like to thank SEER program for public access to the database.

Funding

None.

Author information

Correspondence to Weihui Liu.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. We obtained the authorization to access the SEER database, with the number 14260-Nov2016.

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The SEER database does not reveal patient privacy, so patient informed consent is not required.

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Zhuang, W., Chen, J., Li, Y. et al. Valuation of lymph node dissection in localized high-risk renal cell cancer using X-tile software. Int Urol Nephrol 52, 253–262 (2020). https://doi.org/10.1007/s11255-019-02307-x

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Keywords

  • Localized high-risk renal cell cancer
  • Lymph node dissection
  • SEER database
  • X-tile
  • Survival