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523 Impact of lymph node dissection at the time of radical nephrectomy and tumour thrombectomy on oncological outcomes of patients with renal cell carcinoma and tumour thrombus
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Impact of lymph node dissection at the time of radical nephrectomy and tumour thrombectomy on oncological outcomes of patients with renal cell carcinoma and tumour thrombus Eur Urol Suppl 2016;15(3);e523
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Tilki D.2 , Terrone C.1 , Chandrasekar T.2 , Ciancio G.3 , Daneshmand S. 4 , Martinez-Salamanca J. 5 , Montorsi F.6 , Rodriguez-Faba O.7 , Zigeuner R.8 , Libertino J. 9 , Evans C.2 1 Maggiore
Della Carita Hospital, University of Eastern Piedmont, Division of Urology, Novara, Italy, 2 University of California, Davis, School
of Medicine, Dept. of Urology, Sacramento, United States of America, 3 University of Miami, Miami Transplant Institute, Miami, United States of America, 4 USC/Norris Comprehensive Cancer Center, Dept. of Urology, Los Angeles, United States of America, 5 Hospital Universitario Puerta De Hierro-Majadahonda, Universidad Autónoma De Madrid, Dept. of Urology, Madrid, Spain, 6 Hospital San Raffaele, University Vita-Salute, Dept. of Urology, Milan, Italy, 7 Fundació Puigvert, Dept. of Urology, Barcelona, Spain, 8 Medical University of Graz, Dept. of Urology, Graz, Austria, 9 Lahey Clinic, Dept. of Urology, Burlington, United States of America INTRODUCTION & OBJECTIVES: To analyse the impact of lymph node dissection (LND) at the time of nephrectomy and tumour thrombectomy on oncological outcomes in patients with renal cell carcinoma (RCC) and tumour thrombus. MATERIAL & METHODS: The records of 1978 patients with RCC and tumour thrombus without distant metastasis who underwent radical nephrectomy and tumour thrombectomy from 1985 to 2014 at 24 centers in the United States and Europe were analysed. Extent and pathologic results of lymph node dissection were compared with respect to patients’ cancer-specific survival (CSS). Multivariable Cox regression models were used to quantify the impact of multiple covariates. RESULTS: Overall 5-year-CSS was 60.9% (CI 58.1%-63.5%) in the entire group. LND was performed in 1026 patients. Lymph node (LN) metastases were present in 223 (21.7%) of these patients. In the entire cohort of patients undergoing lymphadenectomy, mean (median) number of removed LN was 11.2 (7) and mean (median) number of positive LN was 4.1 (2). In the lymph node positive patients, mean (median) number of removed LN was 13.1 (9). In multivariate analysis, the presence of lymph node metastasis, the number of positive LNs and lymph node density were independently associated with CSS. The number of removed lymph nodes did not have a significant effect on survival in pN0 or pN1 patients. Clinical node negative (cN-) disease was documented in 573 patients, 404 of these received a lymphadenectomy with 43 cN- patients (10.6%) revealing positive lymph nodes at pathology. CONCLUSIONS: In our multi-institutional series of patients with RCC who underwent radical nephrectomy and tumour thrombectomy, the number of positive nodes harvested during LND and LN density were strong prognostic indicators of cancer-specific survival. The number of removed lymph nodes was not prognostic of cancer specific survival. The rate of pN1 patients among clinically node-negative patients was high and warrants a LND in these patients.
Impact of lymph node dissection at the time of radical nephrectomy and tumour thrombectomy on oncological outcomes of patients with renal cell carcinoma and tumour thrombus Eur Urol Suppl 2016;15(3);e523
Print! Print!
Tilki D.2 , Terrone C.1 , Chandrasekar T.2 , Ciancio G.3 , Daneshmand S. 4 , Martinez-Salamanca J. 5 , Montorsi F.6 , Rodriguez-Faba O.7 , Zigeuner R.8 , Libertino J. 9 , Evans C.2 1 Maggiore
Della Carita Hospital, University of Eastern Piedmont, Division of Urology, Novara, Italy, 2 University of California, Davis, School
of Medicine, Dept. of Urology, Sacramento, United States of America, 3 University of Miami, Miami Transplant Institute, Miami, United States of America, 4 USC/Norris Comprehensive Cancer Center, Dept. of Urology, Los Angeles, United States of America, 5 Hospital Universitario Puerta De Hierro-Majadahonda, Universidad Autónoma De Madrid, Dept. of Urology, Madrid, Spain, 6 Hospital San Raffaele, University Vita-Salute, Dept. of Urology, Milan, Italy, 7 Fundació Puigvert, Dept. of Urology, Barcelona, Spain, 8 Medical University of Graz, Dept. of Urology, Graz, Austria, 9 Lahey Clinic, Dept. of Urology, Burlington, United States of America INTRODUCTION & OBJECTIVES: To analyse the impact of lymph node dissection (LND) at the time of nephrectomy and tumour thrombectomy on oncological outcomes in patients with renal cell carcinoma (RCC) and tumour thrombus. MATERIAL & METHODS: The records of 1978 patients with RCC and tumour thrombus without distant metastasis who underwent radical nephrectomy and tumour thrombectomy from 1985 to 2014 at 24 centers in the United States and Europe were analysed. Extent and pathologic results of lymph node dissection were compared with respect to patients’ cancer-specific survival (CSS). Multivariable Cox regression models were used to quantify the impact of multiple covariates. RESULTS: Overall 5-year-CSS was 60.9% (CI 58.1%-63.5%) in the entire group. LND was performed in 1026 patients. Lymph node (LN) metastases were present in 223 (21.7%) of these patients. In the entire cohort of patients undergoing lymphadenectomy, mean (median) number of removed LN was 11.2 (7) and mean (median) number of positive LN was 4.1 (2). In the lymph node positive patients, mean (median) number of removed LN was 13.1 (9). In multivariate analysis, the presence of lymph node metastasis, the number of positive LNs and lymph node density were independently associated with CSS. The number of removed lymph nodes did not have a significant effect on survival in pN0 or pN1 patients. Clinical node negative (cN-) disease was documented in 573 patients, 404 of these received a lymphadenectomy with 43 cN- patients (10.6%) revealing positive lymph nodes at pathology. CONCLUSIONS: In our multi-institutional series of patients with RCC who underwent radical nephrectomy and tumour thrombectomy, the number of positive nodes harvested during LND and LN density were strong prognostic indicators of cancer-specific survival. The number of removed lymph nodes was not prognostic of cancer specific survival. The rate of pN1 patients among clinically node-negative patients was high and warrants a LND in these patients.