Radical Nephrectomy with or without Lymph Node Dissection for pT3 Renal Cell Carcinoma: A Propensity Score-based...

Area of Science:

• Urology
• Oncology
• Surgical Pathology

Background:

• Renal cell carcinoma (RCC) is a significant health concern.
• The role of lymph node dissection (LND) in radical nephrectomy (RN) for pT3 RCC remains debated.
• The 2018 American Joint Committee on Cancer TNM classification system provides updated staging criteria.

Purpose of the Study:

• To evaluate the survival benefit of LND in conjunction with RN for pT3 RCC patients.
• To compare outcomes between pT3 RCC patients who underwent RN with LND versus RN alone.
• To investigate the impact of the number of lymph nodes removed on survival.

Main Methods:

• Retrospective cohort study of 245 pT3 RCC patients undergoing RN.
• 1:1 propensity score (PS) matching to compare LND and non-LND groups.
• Kaplan-Meier and Cox regression analyses for survival (PFS, CSS, OS).
• Validation using TCGA KIRC database.

Main Results:

• Propensity score matching created 67 pairs for analysis.
• No significant difference in progression-free survival (PFS), cancer-specific survival (CSS), or overall survival (OS) between LND and non-LND groups.
• Removal of 5 or more lymph nodes was associated with a negative effect on OS (p=0.0387).
• TCGA cohort results corroborated these findings.

Conclusions:

• Radical nephrectomy with lymph node dissection does not improve PFS, CSS, or OS in pT3 RCC patients.
• Extensive lymph node dissection (≥5 nodes) may be detrimental to overall survival.
• Current evidence suggests LND is not routinely beneficial for pT3 RCC.