Michele Marchioni1,2, Marco Bandini2,3, Raisa S Pompe2,4, Tristan Martel2,5, Zhe Tian2, Shahrokh F Shariat6, Anil Kapoor7, Luca Cindolo8, Alberto Briganti3, Luigi Schips8, Umberto Capitanio3, Pierre I Karakiewicz2,5. 1. Department of Urology, SS Annunziata Hospital, 'G. D'Annunzio' University of Chieti, Chieti, Italy. 2. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada. 3. Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy. 4. Martini Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 5. Department of Urology, University of Montreal Health Center, Montreal, QC, Canada. 6. Department of Urology, Medical University of Vienna, Vienna, Austria. 7. Division of Urology, McMaster University, Hamilton, ON, Canada. 8. Department of Urology, ASL Abruzzo 2, Chieti, Italy.
Abstract
OBJECTIVE: To assess the effect of lymph node dissection (LND), number of removed nodes (NRN), and number of positive nodes (NPN), on cancer-specific mortality (CSM) in contemporary vs historical patients with pT2-3 Nany M0 renal cell carcinoma (RCC) treated with radical nephrectomy (RN). PATIENTS AND METHODS: Within the Surveillance, Epidemiology, and End Results database (2001-2013), we identified patients with non-metastatic pT2-3 Nany RCC who underwent RN with or without LND. Kaplan-Meier analyses and multivariable Cox regression models with propensity score weighting for inverse probability of treatment were used. RESULTS: Of 25 357 patients, 24.8% underwent LND (2001-2007: 3 167 patients vs 2008-2013: 3 133 patients). The median NRN was 3 (interquartile range [IQR]: 1-7). Positive nodes were identified in 17.1%: 9.3% of pT2 and 21.6% of pT3 patients, who underwent LND. The median NPN was 2 (IQR: 1-3). In multivariable models, LND did not decrease CSM (hazard ratio [HR] 1.29; P < 0.001). LND extent, defined as NRN, did not decrease CSM (HR 0.94; P = 0.3). Finally, multivariable models testing the effect of NPN showed increased CSM in pT3 but not in pT2 patients (HR 1.29 and 1.58, P = 0.02 and P = 0.1, respectively). NRN exerted a protective effect on CSM in patients with positive nodes (HR 0.98; P = 0.007). CONCLUSION: In contemporary and historical patients LND or its extent do not protect from CSM. However, the NPN increases the rate of CSM in pT3 patients. Consequently, LND and its extent appear to have little if any therapeutic value in pT2-3 Nany M0 patients, besides its prognostic impact. High-risk non-metastatic patients may represent a target population for a multi-institutional prospective trial.
OBJECTIVE: To assess the effect of lymph node dissection (LND), number of removed nodes (NRN), and number of positive nodes (NPN), on cancer-specific mortality (CSM) in contemporary vs historical patients with pT2-3 Nany M0 renal cell carcinoma (RCC) treated with radical nephrectomy (RN). PATIENTS AND METHODS: Within the Surveillance, Epidemiology, and End Results database (2001-2013), we identified patients with non-metastatic pT2-3 Nany RCC who underwent RN with or without LND. Kaplan-Meier analyses and multivariable Cox regression models with propensity score weighting for inverse probability of treatment were used. RESULTS: Of 25 357 patients, 24.8% underwent LND (2001-2007: 3 167 patients vs 2008-2013: 3 133 patients). The median NRN was 3 (interquartile range [IQR]: 1-7). Positive nodes were identified in 17.1%: 9.3% of pT2 and 21.6% of pT3 patients, who underwent LND. The median NPN was 2 (IQR: 1-3). In multivariable models, LND did not decrease CSM (hazard ratio [HR] 1.29; P < 0.001). LND extent, defined as NRN, did not decrease CSM (HR 0.94; P = 0.3). Finally, multivariable models testing the effect of NPN showed increased CSM in pT3 but not in pT2 patients (HR 1.29 and 1.58, P = 0.02 and P = 0.1, respectively). NRN exerted a protective effect on CSM in patients with positive nodes (HR 0.98; P = 0.007). CONCLUSION: In contemporary and historical patients LND or its extent do not protect from CSM. However, the NPN increases the rate of CSM in pT3 patients. Consequently, LND and its extent appear to have little if any therapeutic value in pT2-3 Nany M0 patients, besides its prognostic impact. High-risk non-metastatic patients may represent a target population for a multi-institutional prospective trial.
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