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Outcome after resection of occult and non-occult lymph node metastases at the time of nephrectomy

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Abstract

Purpose

There is sparse evidence on outcomes of resected occult LN metastases at the time of nephrectomy (synchronous disease). We sought to analyse a large international cohort of patients and to identify clinico-pathological predictors of long-term survival.

Materials and methods

We collected data of consecutive patients who underwent nephrectomy and LND for Tany cN0-1pN1 and cM0-1 RCC at 7 referral centres between 1988 and 2019. Patients were stratified into four clinico-pathological groups: (1) cN0cM0-pN1, (2) cN1cM0-pN1(limited, 1–3 positive nodes), (3) cN1cM0-pN1(extensive, > 3 positive nodes), and (4) cM1-pN1. Overall survival (OS) was estimated using the Kaplan–Meier method, and associations with all-cause mortality (ACM) were evaluated using Cox models with multiple imputations.

Results

Of the 4370 patients with LND, 292 patients with pN1 disease were analysed. Median follow-up was 62 months, during which 171 patients died. Median OS was 21 months (95% CI 17–30 months) and the 5-year OS rate was 24% (95% CI 18–31%). Patients with cN0cM0-pN1 disease had a median OS of 57 months and a 5-year OS rate of 43%. 5-year OS (median OS) decreased to 29% (33 months) in cN1cM0-pN1(limited) and to 23% (23 months) in cN1cM0-pN1(extensive) patients. Those with cM1-pN1 disease had the worst prognosis, with a 5-year OS rate of 13% (9 months). On multivariable analysis, age (p = 0.034), tumour size (p = 0.02), grade (p = 0.02) and clinico-pathological group (p < 0.05) were significant predictors of ACM.

Conclusion

Depending on clinico-pathological group, grade and tumour size, 5-year survival of patients with LN metastases varies from 13 to 43%. Patients with resected occult lymph node involvement (cN0/pN1 cM0) have the best prognosis with a considerable chance of long-term survival.

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References

  1. Chandrasekar T, Klaassen Z, Goldberg H et al (2017) Metastatic renal cell carcinoma: patterns and predictors of metastases-a contemporary population-based series. Urol Oncol 35(11):661.e7-661.e14

    Article  Google Scholar 

  2. Bhindi B, Wallis CJD, Boorjian SA et al (2018) The role of lymph node dissection in the management of renal cell carcinoma: a systematic review and meta-analysis. BJU Int 121(5):684–698

    Article  Google Scholar 

  3. Delacroix SE Jr, Chapin BF, Chen JJ et al (2011) Can a durable disease-free survival be achieved with surgical resection in patients with pathological node positive renal cell carcinoma? J Urol 186:1236–1241

    Article  Google Scholar 

  4. Gershman B, Moreira DM, Thompson RH et al (2017) Renal cell carcinoma with isolated lymph node involvement: long-term natural history and predictors of oncologic outcomes following surgical resection. Eur Urol 72:300–306

    Article  Google Scholar 

  5. Canfield SE, Kamat AM, Sanchez-Ortiz RF et al (2006) Renal cell carcinoma with nodal metastases in the absence of distant metastatic disease (clinical stage TxN1-2M0): the impact of aggressive surgical resection on patient outcome. J Urol 175:864–869

    Article  Google Scholar 

  6. Leibovich BC, Lohse CM, Cheville JC et al (2018) Predicting oncologic outcomes in renal cell carcinoma after surgery. Eur Urol 73(5):772–780

    Article  Google Scholar 

  7. Rieken M, Boorjian SA, Kluth LA et al (2019) Development and external validation of a pathological nodal staging score for patients with clear cell renal cell carcinoma. World J Urol 37(8):1631–1637

    Article  Google Scholar 

  8. Leibovich BC, Lohse CM, Cheville JC, Zaid HB, Boorjian SA, Frank I, Thompson RH, Parker WP (2018) Predicting oncologic outcomes in renal cell carcinoma after surgery. Eur Urol 73(5):772–780

    Article  Google Scholar 

  9. Rosiello G, Palumbo C, Knipper S et al (2020) Histotype predicts the rate of lymph node invasion at nephrectomy in patients with nonmetastatic renal cell carcinoma. Urol Oncol 38:537–544

    Article  Google Scholar 

  10. Blom JH, van Poppel H, Marechal JM et al (2009) Radical nephrectomy with and without lymph-node dissection: final results of European Organization for Research and Treatment of Cancer (EORTC) randomized phase 3 trial 30881. Eur Urol 55:28–34

    Article  Google Scholar 

  11. Bacic J, Liu T, Thompson RH et al (2020) Emulating target clinical trials of radical nephrectomy with or without lymph node dissection for renal cell carcinoma. Urology 140:98–106

    Article  Google Scholar 

  12. Ljungberg B, Albiges L, Abu-Ghanem Y et al (2019) European Association of Urology guidelines on renal cell carcinoma: the 2019 update. Eur Urol 75(5):799–810

    Article  Google Scholar 

  13. Escudier B, Porta C, Schmidinger M, Rioux-Leclercq N et al (2019) Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 30(5):706–720

    Article  CAS  Google Scholar 

  14. Motzer RJ, Jonasch E, Agarwal N et al (2015) Kidney cancer, version 3.2015. J Natl Compr Canc Netw 13(2):151–159

    Article  Google Scholar 

  15. Campbell S, Uzzo RG, Allaf ME et al (2017) Renal mass and localized renal cancer: AUA guideline. J Urol 198(3):520–529

    Article  Google Scholar 

  16. Pantuck AJ, Zisman A, Dorey F et al (2003) Renal cell carcinoma with retroperitoneal lymph nodes: role of lymph node dissection. J Urol 169:2076–2083

    Article  Google Scholar 

  17. Whitson JM, Harris CR, Reese AC et al (2011) Lymphadenectomy improves survival of patients with renal cell carcinoma and nodal metastases. J Urol 185:1615–1620

    Article  Google Scholar 

  18. Karakiewicz PI, Trinh QD, Bhojani N et al (2007) Renal cell carcinoma with nodal metastases in the absence of distant metastatic disease: prognostic indicators of disease-specific survival. Eur Urol 51:1616–1624

    Article  Google Scholar 

  19. Capitanio U, Suardi N, Matloob R et al (2014) Extent of lymph node dissection at nephrectomy affects cancer-specific survival and metastatic progression in specific sub-categories of patients with renal cell carcinoma (RCC). BJU Int 114:210–215

    Article  Google Scholar 

  20. Golijanin B, Pereira J, Mueller-Leonhard C et al (2019) The natural history of renal cell carcinoma with isolated lymph node metastases following surgical resection from 2006 to 2013. Urol Oncol 37(12):932–940

    Article  Google Scholar 

  21. Kuusk T, Zondervan P, Lagerveld B et al (2020) Topographic distribution of first landing sites of lymphatic metastases from patients with renal cancer. Urol Oncol 38(5):521–525

    Article  CAS  Google Scholar 

  22. Sobin LH, Gospodarowicz MK, Wittekind C (2009) TNM Classification of Malignant Tumours, 7th edn. Wiley-Blackwell, Chichester, pp 255–257

    Google Scholar 

  23. White IR, Royston P (2009) Imputing missing covariate values for the Cox model. Stat Med 28:1982–1998

    Article  Google Scholar 

  24. Marshall A, Altman DG, Holder RL et al (2009) Combining estimates of interest in prognostic modelling studies after multiple imputation: current practice and guidelines. BMC Med Res Methodol 9:57

    Article  Google Scholar 

  25. Belsante M, Darwish O, Youssef R et al (2014) Lymphovascular invasion in clear cell renal cell carcinoma-association with disease-free and cancer-specific survival. Urol Oncol 32(1):30.e23–8

    Article  Google Scholar 

  26. Yu KJ, Keskin SK, Meissner MA et al (2018) Renal cell carcinoma and pathologic nodal disease: Implications for American Joint Committee on Cancer staging. Cancer 124(20):4023–4031

    Article  Google Scholar 

  27. Zareba P, Russo P (2019) The prognostic significance of nodal disease burden in patients with lymph node metastases from renal cell carcinoma. Urol Oncol 37(5):302.e1-302.e6

    Article  Google Scholar 

  28. Terrone C, Cracco C, Porpiglia F et al (2006) Reassessing the current TNM lymph node staging for renal cell carcinoma. Eur Urol 49(2):324–331

    Article  Google Scholar 

  29. Trinh QD, Schmitges J, Bianchi M et al (2012) Node-positive renal cell carcinoma in the absence of distant metastases: predictors of cancer-specific mortality in a population-based cohort. BJU Int 110:E21–E27

    Article  Google Scholar 

  30. Bex A, Vermeeren L, de Windt G et al (2010) Feasibility of sentinel node detection in renal cell carcinoma: a pilot study. Eur J Nucl Med Mol Imaging 37(6):1117–1123

    Article  Google Scholar 

  31. Kuusk T, De Bruijn R, Brouwer OR et al (2018) Lymphatic drainage from renal tumors in vivo: a prospective sentinel node study using SPECT/CT imaging. J Urol 199(6):1426–1432

    Article  Google Scholar 

  32. Verhoeff SR, van Es SC, Boon E et al (2019) Lesion detection by [89Zr]Zr-DFO-girentuximab and [18F]FDG-PET/CT in patients with newly diagnosed metastatic renal cell carcinoma. Eur J Nucl Med Mol Imaging 46(9):1931–1939

    Article  CAS  Google Scholar 

Download references

Funding

No funds, grants, or other support was received. The authors have no relevant financial or non-financial interests to disclose.

Author information

Authors and Affiliations

  1. Department of Urology, Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford, UK

    Teele Kuusk

  2. Department of Urology, Renal Cancer Unit, Royal Free Hospital, London, UK

    Teele Kuusk & Axel Bex

  3. Department of Surgery, University of Cambridge, Cambridge, UK

    Tobias Klatte & Grant D. Stewart

  4. Department of Urology, Royal Bournemouth Hospital, Bournemouth, UK

    Tobias Klatte

  5. Department of Urology, Academic Medical Center, Amsterdam, The Netherlands

    Patricia Zondervan

  6. Department of Urology, OLVG, Amsterdam, The Netherlands

    Brunolf Lagerveld

  7. Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands

    Niels Graafland, Kees Hendricksen, Simon Horenblas & Axel Bex

  8. Department of Urology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Umberto Capitanio

  9. Department of Urology, Careggi Hospital, University of Florence, Florence, Italy

    Andrea Minervini

  10. Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden

    Borje Ljungberg

Authors
  1. Teele Kuusk
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  2. Tobias Klatte
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  3. Patricia Zondervan
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  12. Axel Bex
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Contributions

TK: protocol/project development, data collection or management and manuscript writing/editing. TK: data analysis and manuscript writing/editing. PZ: data collection or management and manuscript writing/editing. BL: data collection or management and manuscript writing/editing. NG: data collection or management and manuscript writing/editing. KH: data collection or management and manuscript writing/editing. UC: data collection or management and manuscript writing/editing. AM: data collection or management and manuscript writing/editing. DGS: data collection or management and manuscript writing/editing. BL: data collection or management and manuscript writing/editing. SH: data collection or management, manuscript writing/editing. AB: protocol/project development, data collection or management and manuscript writing/editing.

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Correspondence to Axel Bex.

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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.

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Kuusk, T., Klatte, T., Zondervan, P. et al. Outcome after resection of occult and non-occult lymph node metastases at the time of nephrectomy. World J Urol 39, 3377–3383 (2021). https://doi.org/10.1007/s00345-021-03633-5

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  • DOI: https://doi.org/10.1007/s00345-021-03633-5

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