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Lymphadenopathies in patients with renal cell carcinoma: clinical and pathological predictors of pathologically confirmed lymph node invasion

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Abstract

Introduction

In renal cell carcinoma (RCC), lymph node status at preoperative imaging is affected by a non-negligible false-positive rate. We aimed to investigate which factors are related to a concordance between clinical suspicion and pathological confirmation of lymph node invasion (LNI).

Methods

At a single tertiary care institution, 2954 RCC patients underwent either partial or radical nephrectomy. For the aim of the study, only clinically positive lymph node cases were included (cN1). Statistical analyses assessed the concordance between preoperative and pathological nodal status.

Results

Preoperative axial CT scans revealed 424 (14.4 %) patients showing at least one enlarged lymph node suspected for LNI (cN1). All lymphadenopathies were removed at surgery, and LNI was pathologically confirmed (pN1) in 122 patients (28.8 %). When focusing the analyses on clinical characteristics (variables known before surgery), metastases at diagnosis [OR 3.0 (95 %1.9–4.8), p < 0.001] and tumor size [OR 1.1 (95 % 1.1–1.2), p < 0.001] were the two most informative predictors of concordance between clinical and pathological nodal status. Concordance was also more likely in patients with papillary type II tumors (55.6 %) relative to papillary type I (38.1 %), clear cell (27.7 %) and chromophobe (8.3 %) tumors. At multivariable analyses, none of the considered blood markers resulted to be independently associated with LNI.

Conclusions

Roughly 70 % of patients showing a suspected lymph node preoperatively do not show LNI at the final pathological report. Among patients with clinically positive nodes, clinical tumor size and metastases at diagnosis represent the most informative and independent predictors of confirmed LNI at final pathology.

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Authors’ contribution

Capitanio, Deho’, Dell’Oglio, Larcher, Capogrosso, Nini, Briganti and Bertini involved in protocol/project development. Capitanio, Deho’, Dell’Oglio, Larcher, Capogrosso, Nini, Carenzi, Freschi, Montorsi and Bertini involved in data collection or management. Capitanio, Dell’Oglio, Larcher, Nini and Carenzi involved in data analysis. Capitanio, Deho’, Dell’Oglio, Larcher, Capogrosso, Nini, Carenzi, Freschi, Briganti, Salonia, Montorsi and Bertini wrote and edited the manuscript.

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Authors and Affiliations

  1. Unit of Urology, University Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy

    Umberto Capitanio, Federico Deho’, Paolo Dell’Oglio, Alessandro Larcher, Paolo Capogrosso, Alessandro Nini, Alberto Briganti, Andrea Salonia, Francesco Montorsi & Roberto Bertini

  2. Division of Experimental Oncology, URI, Urological Research Institute, Renal Cancer Unit, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy

    Umberto Capitanio, Paolo Dell’Oglio, Alessandro Larcher, Paolo Capogrosso, Alessandro Nini, Cristina Carenzi, Alberto Briganti, Andrea Salonia & Francesco Montorsi

  3. Department of Pathology, University Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy

    Massimo Freschi

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  1. Umberto Capitanio
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  2. Federico Deho’
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  3. Paolo Dell’Oglio
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  4. Alessandro Larcher
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  5. Paolo Capogrosso
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  6. Alessandro Nini
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  7. Cristina Carenzi
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  8. Massimo Freschi
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  9. Alberto Briganti
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  10. Andrea Salonia
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  11. Francesco Montorsi
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  12. Roberto Bertini
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Corresponding author

Correspondence to Umberto Capitanio.

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There are no financial or non-financial conflicts; informed consent was collected from the patients; animals were not involved.

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Capitanio, U., Deho’, F., Dell’Oglio, P. et al. Lymphadenopathies in patients with renal cell carcinoma: clinical and pathological predictors of pathologically confirmed lymph node invasion. World J Urol 34, 1139–1145 (2016). https://doi.org/10.1007/s00345-015-1747-5

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  • DOI: https://doi.org/10.1007/s00345-015-1747-5

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