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Lymph node dissection during cytoreductive nephrectomy: a retrospective analysis.

Michael A Feuerstein1, Matthew Kent, Melanie Bernstein

  • 1Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.

International Journal of Urology : Official Journal of the Japanese Urological Association
|April 10, 2014
PubMed
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Regional lymph node dissection during cytoreductive nephrectomy does not improve survival for metastatic renal cell carcinoma patients. Positive lymph node disease is a poor prognostic indicator, suggesting dissection is best for staging in clinical trials.

Area of Science:

  • Oncology
  • Surgical Oncology
  • Renal Cell Carcinoma Research

Background:

  • Metastatic renal cell carcinoma (mRCC) presents significant treatment challenges.
  • Cytoreductive nephrectomy is a treatment option for some mRCC patients.
  • The role of regional lymph node dissection (LND) in mRCC prognosis remains unclear.

Purpose of the Study:

  • To determine if regional lymph node dissection improves survival in patients with metastatic renal cell carcinoma undergoing cytoreductive nephrectomy.
  • To identify prognostic factors associated with lymph node status in mRCC.

Main Methods:

  • Retrospective review of 258 patients undergoing cytoreductive nephrectomy.
  • Analysis of overall survival using Cox proportional hazards regression.
Keywords:
carcinomacytoreductive nephrectomylymph node dissectionmetastaticrenal cell

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  • Logistic regression used to identify risk factors for node-positive disease.
  • Survival analysis stratified by lymph node template and number of nodes removed.
  • Main Results:

    • 177 patients (69%) underwent lymph node dissection; 59 (33%) had positive nodes.
    • No significant difference in 5-year overall survival between patients with and without LND (21% vs. 31%).
    • Positive lymph node status was a significant predictor of poor prognosis (5-year survival 9% vs. 27% for negative nodes).
    • Lymphadenopathy was a strong predictor of node-positive disease in patients undergoing LND.

    Conclusions:

    • Regional lymph node dissection during cytoreductive nephrectomy does not confer a survival benefit for mRCC patients.
    • Lymph node-positive disease is a critical negative prognostic factor.
    • Lymph node dissection may serve as a valuable staging procedure within clinical trials for mRCC.