U Capitanio1, G D Stewart2, A Larcher3, I Ouzaid4, B Akdogan5, M Roscigno6, M Marszalek7, P Dell'Oglio3, M Salagierski8, A Volpe9, M C Mir10, M Kriegmair11, C Terrone9, S D Brookman-May12, F Montorsi3, T Klatte13. 1. Unit of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy; Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy. Electronic address: umbertocapitanio@gmail.com. 2. Edinburgh Urological Cancer Group, University of Edinburgh, Western General Hospital, Edinburgh, UK. 3. Unit of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy; Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy. 4. Bichat University Hospital, France. 5. Hacettepe University, Ankara, Turkey. 6. Papa Giovanni XXIII Hospital, Bergamo, Italy. 7. Radboud University Medical Center, Nijmegen, The Netherlands. 8. Kent & Canterbury Hospital, Canterbury, UK. 9. Universita' Del Piemonte Orientale Ospedale Maggiore Della Carita', Novara, Italy. 10. Hospital del Mar-Parc de Salut Mar-IMIM, Barcelona, Spain. 11. University Medical Center Mannheim, Germany. 12. Ludwig-Maximilians University Munich, Department of Urology, Campus Grosshadern, Munich, Germany; Janssen Pharma Research and Development, Los Angeles, United States. 13. Medical University of Vienna, Vienna, Austria.
Abstract
BACKGROUND: The role of lymph node dissection (LND) in renal cell carcinoma (RCC) is still under debate. We aimed to assess the utilization rates of LND over time in Europe. METHODS: A multi-institutional database of 13,581 RCC patients who underwent radical nephrectomy (RN) or nephron sparing surgery (NSS) between 1988 and 2014 was created within an European consortium. We analysed temporal trends in the frequency of LND by using Joinpoint regression. Logistic regression models were used to identify predictors of LND. RESULTS: Overall, 5114 patients (42.7%) underwent LND. Lymph node invasion was recorded in 566 cases (11% of LND patients) which represents 4.7% of the whole study cohort. A gradual decline in the use of LND started in the 1990s. After 2008 LND decreased significantly by 21.5% per year (95%CI -33.3 to -7.5, p < 0.01) until 2011 and stabilized thereafter (Annual Percentage Change 4.9%, 95%CI -3.4 to 13.8, p = 0.2). At multivariable analyses, patient age (OR 0.98, p < 0.0001), type of surgery (RN vs. NSS: OR 5.46, p < 0.0001), surgical approach (open vs. minimally invasive: OR 1.75, p < 0.0001), T stage (T2 vs. T1: OR 1.57; T3-4 vs. T1: OR 1.44, p < 0.0001), clinical tumour size (OR 1.14, p < 0.0001), and year of surgery (OR 0.95, p < 0.0001) were associated with higher probability of LND at nephrectomy. CONCLUSIONS: A trend towards lower LND was observed over time for RCC patients who underwent RN or NSS. LND is more frequently performed in younger patients, locally advanced diseases and in case of open surgery.
BACKGROUND: The role of lymph node dissection (LND) in renal cell carcinoma (RCC) is still under debate. We aimed to assess the utilization rates of LND over time in Europe. METHODS: A multi-institutional database of 13,581 RCCpatients who underwent radical nephrectomy (RN) or nephron sparing surgery (NSS) between 1988 and 2014 was created within an European consortium. We analysed temporal trends in the frequency of LND by using Joinpoint regression. Logistic regression models were used to identify predictors of LND. RESULTS: Overall, 5114 patients (42.7%) underwent LND. Lymph node invasion was recorded in 566 cases (11% of LND patients) which represents 4.7% of the whole study cohort. A gradual decline in the use of LND started in the 1990s. After 2008 LND decreased significantly by 21.5% per year (95%CI -33.3 to -7.5, p < 0.01) until 2011 and stabilized thereafter (Annual Percentage Change 4.9%, 95%CI -3.4 to 13.8, p = 0.2). At multivariable analyses, patient age (OR 0.98, p < 0.0001), type of surgery (RN vs. NSS: OR 5.46, p < 0.0001), surgical approach (open vs. minimally invasive: OR 1.75, p < 0.0001), T stage (T2 vs. T1: OR 1.57; T3-4 vs. T1: OR 1.44, p < 0.0001), clinical tumour size (OR 1.14, p < 0.0001), and year of surgery (OR 0.95, p < 0.0001) were associated with higher probability of LND at nephrectomy. CONCLUSIONS: A trend towards lower LND was observed over time for RCCpatients who underwent RN or NSS. LND is more frequently performed in younger patients, locally advanced diseases and in case of open surgery.
Authors: Giuseppe Fallara; Alessandro Larcher; Giuseppe Rosiello; Daniele Raggi; Laura Marandino; Alberto Martini; Giuseppe Basile; Gianmarco Colandrea; Daniele Cignoli; Federico Belladelli; Chiara Re; Giacomo Musso; Francesco Cei; Roberto Bertini; Alberto Briganti; Andrea Salonia; Francesco Montorsi; Andrea Necchi; Umberto Capitanio Journal: World J Urol Date: 2022-09-20 Impact factor: 3.661