Derya Tilki1, Thenappan Chandrasekar1, Umberto Capitanio2, Gaetano Ciancio3, Siamak Daneshmand4, Paolo Gontero5, Javier Gonzalez6, Axel Haferkamp7, Markus Hohenfellner8, William C Huang9, Estefania Linares Espinós10, Adam Lorentz11, Juan I Martinez-Salamanca12, Viraj A Master11, James M McKiernan13, Francesco Montorsi2, Giacomo Novara14, Sascha Pahernik8, Juan Palou15, Raj S Pruthi16, Oscar Rodriguez-Faba15, Paul Russo17, Douglas S Scherr18, Shahrokh F Shariat19, Martin Spahn20, Carlo Terrone21, Cesar Vera-Donoso22, Richard Zigeuner23, John A Libertino24, Christopher P Evans25. 1. Department of Urology, University of California, Davis School of Medicine, Sacramento, CA. 2. Department of Urology, Hospital San Raffaele, University Vita-Salute, Milano, Italy. 3. Department of Urology, Miami Transplant Institute, University of Miami, Miami, FL. 4. Department of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, CA. 5. Department of Urology, A.O.U. San Giovanni Battista, University of Turin, Turin, Italy. 6. Department of Urology, Hospital Central de la Cruz Roja San José y Santa Adela, Madrid, Spain. 7. Department of Urology, University of Frankfurt, Frankfurt, Germany. 8. Department of Urology, University of Heidelberg, Heidelberg, Germany. 9. Department of Urology, New York University School of Medicine, New York City, NY. 10. Department of Urology, Hospital Universitario Infanta Sofía, Madrid, Spain. 11. Department of Urology, Emory University, Atlanta, GA. 12. Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain. 13. Department of Urology, Columbia University College of Physicians and Surgeons, New York City, NY. 14. Department of Urology, University of Padua, Padua, Italy. 15. Department of Urology, Fundació Puigvert, Barcelona, Spain. 16. Department of Urology, UNC at Chappel Hill, Chapel Hill, NC. 17. Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York City, NY. 18. Department of Urology, Weill Cornell Medical Center, New York City, NY. 19. Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria. 20. Department of Urology, University of Würzburg, Würzburg, Germany; Department of Urology, University Hospital Bern, Bern, Switzerland. 21. Division of Urology, Maggiore della Carita Hospital, University of Eastern Piedmont, Novara, Italy. 22. Department of Urology, Hospital Universitario y Politécnico La Fe, Valencia, Spain. 23. Department of Urology, Medical University of Graz, Graz, Austria. 24. Department of Urology, Lahey Clinic, Burlington, MA. 25. Department of Urology, University of California, Davis School of Medicine, Sacramento, CA. Electronic address: cpevans@ucdavis.edu.
Abstract
OBJECTIVES: To study the effect of lymph node dissection (LND) at the time of nephrectomy and tumor thrombectomy on oncological outcomes in patients with renal cell carcinoma (RCC) and tumor thrombus. PATIENTS AND METHODS: The records of 1,978 patients with RCC and tumor thrombus who underwent radical nephrectomy and tumor thrombectomy from 1985 to 2014 at 24 centers were analyzed. None of the patients had distant metastases. Extent and pathologic results of LND were compared with respect to cancer-specific survival (CSS). Multivariable Cox regression models were used to quantify the effect of multiple covariates. RESULTS: LND was performed in 1,026 patients. In multivariable analysis, the presence of LN metastasis, the number of positive LNs, and LN density were independently associated with cancer-specific mortality (CSM). Clinical node-negative (cN-) disease was documented in 573 patients, 447 of them underwent LND with 43 cN- patients (9.6%) revealing positive LNs at pathology. LN positive cN- patients showed significantly better CSS when compared to LN positive cN+ patients. In multivariable analysis, positive cN status in LN positive patients was a significant predictor of CSM (HR, 2.923; P = 0.015). CONCLUSIONS: The number of positive nodes harvested during LND and LN density was strong prognostic indicators of CSS, while number of removed LNs did not have a significant effect on CSS. The rate of pN1 patients among clinically node-negative patients was relatively high, and LND in these patients suggested a survival benefit. However, only a randomized trial can determine the absolute benefit of LND in this setting.
OBJECTIVES: To study the effect of lymph node dissection (LND) at the time of nephrectomy and tumor thrombectomy on oncological outcomes in patients with renal cell carcinoma (RCC) and tumor thrombus. PATIENTS AND METHODS: The records of 1,978 patients with RCC and tumor thrombus who underwent radical nephrectomy and tumor thrombectomy from 1985 to 2014 at 24 centers were analyzed. None of the patients had distant metastases. Extent and pathologic results of LND were compared with respect to cancer-specific survival (CSS). Multivariable Cox regression models were used to quantify the effect of multiple covariates. RESULTS: LND was performed in 1,026 patients. In multivariable analysis, the presence of LN metastasis, the number of positive LNs, and LN density were independently associated with cancer-specific mortality (CSM). Clinical node-negative (cN-) disease was documented in 573 patients, 447 of them underwent LND with 43 cN- patients (9.6%) revealing positive LNs at pathology. LN positive cN- patients showed significantly better CSS when compared to LN positive cN+ patients. In multivariable analysis, positive cN status in LN positive patients was a significant predictor of CSM (HR, 2.923; P = 0.015). CONCLUSIONS: The number of positive nodes harvested during LND and LN density was strong prognostic indicators of CSS, while number of removed LNs did not have a significant effect on CSS. The rate of pN1patients among clinically node-negative patients was relatively high, and LND in these patients suggested a survival benefit. However, only a randomized trial can determine the absolute benefit of LND in this setting.
Authors: Jonathan P Walker; Jared S Johnson; Megan M Eguchi; Amanda F Saltzman; Myles Cockburn; Nicholas G Cost Journal: J Pediatr Urol Date: 2019-11-06 Impact factor: 1.830
Authors: Teele Kuusk; Maarten L Donswijk; Renato A Valdés Olmos; Roderick E De Bruijn; Oscar R Brouwer; Kees Hendricksen; Simon Horenblas; Katarzyna Jóźwiak; Warner Prevoo; Henk G Van Der Poel; Bas W G Van Rhijn; Esther M Wit; Axel Bex Journal: EJNMMI Res Date: 2018-12-03 Impact factor: 3.138