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Title
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Prognostic effect of inflammatory lymphadenopathies in renal cell carcinoma patients treated with nephrectomy and extended lymph node dissection Eur Urol Suppl 2015;14/2;e311
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Capitanio U., Di Trapani E., Matloob R., Freschi M., Capogrosso P., Carenzi C., Salonia A., Dell'Oglio P., Briganti A., Gallina A., Montorsi F., Bertini R. San Raffaele Scientific Institute, Dept. of Urology, Milan, Italy INTRODUCTION & OBJECTIVES: In more than half of renal cell carcinoma (RCC) patients with lymphadenopathies at diagnosis (cN1), final pathological examination does not confirm the presence of lymph node invasion (LNI) after surgery. In this context, no study has ever address whether the suspicion of LNI at imaging (cN1 cases) affects RCC specific survival (CSS) if the pathological examination does not confirm lymph node invasion (pN0). MATERIAL & METHODS: Between 1987 and 2012, 1983 RCC patients underwent either partial or radical nephrectomy at a single tertiary care institution. For the aim of the study, only patients submitted to a systematic lymphadenectomy and without pathologically confirmed nodal invasion (pN0) cases were included. Cox regression analyses assessed the effect of clinical nodal status on CSS. Multi-variable analyses were adjusted for age, pathological stage, tumour size, Fuhrman grade, presence of coagulative necrosis, sarcomatoid features and presence of metastases. RESULTS: Among 760 pN0 RCC cases, 93 patients (12.2%) had a preoperative suspicion of nodal invasion at imaging (cN1). Mean age was 61.2 vs. 60.3 in cN1 and cN0, respectively (p=0.5). Mean tumour diameter was 8.6 vs. 7.0 cm in cN1 and cN0, respectively (p=0.001). Pathological T stage resulted pT1, pT2, pT3 and pT4 in 22.0 vs. 45.0%, 16.5 vs. 18.0%, 58.2% vs. 34.5% and 3.3 vs. 2.5% of cN1 and cN0 cases, respectively (p<0.001). Fuhrman grade resulted 3-4 in 60.2 vs. 30.0% in cN1 and cN0 cases, respectively (p<0.001). Metastases at diagnosis were evidenced in 37.6 vs. 12.6% of cN1 and cN0 cases, respectively (p<0.001). Since clinical nodal status (cN1) resulted associated with more unfavourable pathological characteristics, at univariable analysis positive clinical nodal status resulted associated with worse CSS (p<0.001, HR 2.77). However, after adjustment for all possible confounders, the presence of clinical suspicion of nodal invasion did not affect cancer specific survival (p=0.7). CONCLUSIONS: Clinical suspicion of nodal metastases at preoperative imaging (cN1) is associated with more unfavourable pathological characteristics, even in patients with pathological exclusion of nodal invasion (pN0). However, if the pathological examination does not confirm the presence of lymph node invasion (pN0), a radiological suspicion of nodal metastases (cN1) does not independently affect RCC specific survival.
file:///S|/IM/EURSUP/2015%20EAU%20Abstracts/content/data/311.html[19/02/2015 08:10:50]
311
Prognostic effect of inflammatory lymphadenopathies in renal cell carcinoma patients treated with nephrectomy and extended lymph node dissection Eur Urol Suppl 2015;14/2;e311
Print! Print!
Capitanio U., Di Trapani E., Matloob R., Freschi M., Capogrosso P., Carenzi C., Salonia A., Dell'Oglio P., Briganti A., Gallina A., Montorsi F., Bertini R. San Raffaele Scientific Institute, Dept. of Urology, Milan, Italy INTRODUCTION & OBJECTIVES: In more than half of renal cell carcinoma (RCC) patients with lymphadenopathies at diagnosis (cN1), final pathological examination does not confirm the presence of lymph node invasion (LNI) after surgery. In this context, no study has ever address whether the suspicion of LNI at imaging (cN1 cases) affects RCC specific survival (CSS) if the pathological examination does not confirm lymph node invasion (pN0). MATERIAL & METHODS: Between 1987 and 2012, 1983 RCC patients underwent either partial or radical nephrectomy at a single tertiary care institution. For the aim of the study, only patients submitted to a systematic lymphadenectomy and without pathologically confirmed nodal invasion (pN0) cases were included. Cox regression analyses assessed the effect of clinical nodal status on CSS. Multi-variable analyses were adjusted for age, pathological stage, tumour size, Fuhrman grade, presence of coagulative necrosis, sarcomatoid features and presence of metastases. RESULTS: Among 760 pN0 RCC cases, 93 patients (12.2%) had a preoperative suspicion of nodal invasion at imaging (cN1). Mean age was 61.2 vs. 60.3 in cN1 and cN0, respectively (p=0.5). Mean tumour diameter was 8.6 vs. 7.0 cm in cN1 and cN0, respectively (p=0.001). Pathological T stage resulted pT1, pT2, pT3 and pT4 in 22.0 vs. 45.0%, 16.5 vs. 18.0%, 58.2% vs. 34.5% and 3.3 vs. 2.5% of cN1 and cN0 cases, respectively (p<0.001). Fuhrman grade resulted 3-4 in 60.2 vs. 30.0% in cN1 and cN0 cases, respectively (p<0.001). Metastases at diagnosis were evidenced in 37.6 vs. 12.6% of cN1 and cN0 cases, respectively (p<0.001). Since clinical nodal status (cN1) resulted associated with more unfavourable pathological characteristics, at univariable analysis positive clinical nodal status resulted associated with worse CSS (p<0.001, HR 2.77). However, after adjustment for all possible confounders, the presence of clinical suspicion of nodal invasion did not affect cancer specific survival (p=0.7). CONCLUSIONS: Clinical suspicion of nodal metastases at preoperative imaging (cN1) is associated with more unfavourable pathological characteristics, even in patients with pathological exclusion of nodal invasion (pN0). However, if the pathological examination does not confirm the presence of lymph node invasion (pN0), a radiological suspicion of nodal metastases (cN1) does not independently affect RCC specific survival.
file:///S|/IM/EURSUP/2015%20EAU%20Abstracts/content/data/311.html[19/02/2015 08:10:50]