Effect of nodal metastases on cancer-specific mortality after cytoreductive nephrectomy

Relatively few reports have described the outcomes of patients with node-positive renal cell carcinoma (RCC) in the presence of distant metastases. We examined the outcomes of these patients in a large population-based cohort and examined the ability of standard risk factors to predict cancer-specific mortality (CSM).

Using the Surveillance, Epidemiology, and End Results database, 1415 RCC patients with distant metastases undergoing cytoreductive nephrectomy (CNT) were identified. Univariable and multivariable analyses addressed CSM to identify independent predictors of CSM. First, the effect of nodal disease on CSM and overall mortality (OM) was estimated in patients with metastatic disease (N0M1 vs. N1M1). Then, we examined the effect of the number of removed nodes and the number of positive nodes on CSM to quantify the effect on mortality, if any, of the increasing burden of nodal disease.

Actuarial survival estimates demonstrated that for patients with nodal disease 40.2, 23.5 and 11.5 % of patients survived at 12, 24 and 60 months after nephrectomy. In Kaplan-Meier analyses, patients with N1M1 disease had a significantly worse CSM when compared to patients with N0M1 disease (log rank p < 0.001). In multivariable analyses, N1M1 had a 68 and 69 % increase in CSM and OM (vs. N0M1 disease) while, for every additional positive node, CSM and OM increased by 5.1 and 5.6 %.

In patients undergoing CNT, the burden of nodal disease is an independent predictor of CSM, with an incremental effect of every additional positive node.