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The extent of lymphadenectomy does affect cancer specific survival in pathologically confirmed T4 renal cell carcinoma

Abstract

Background: Controversies exist regarding the effect of lymphadenectomy (LND) in renal cell carcinoma (RCC). We hypothesized that patients with locally advanced cancer invading beyond Gerota’s fascia (pT4 Nany Many RCC) might benefit from an extended LND not only for staging but also for survival purposes. Materials and methods: Clinical and pathologic data were prospectively gathered in 1.847 patients treated at a single Academic Center, between 1987 and 2011. Only patients with pT4 RCC (TNM 2009, n=44, 2.4%) were included. Univariable (UVA) and multivariable (MVA) Cox regression analyses targeted the association between the number of lymph nodes removed and cancer specific mortality (CSM). Analyses were adjusted for age, Fuhrman grade, symptoms at presentation, metastases at diagnosis, ECOG performance status, tumor size, number of positive nodes, and presence of necrosis or sarcomatoid features.  Results: Mean number of nodes removed was 11.8 (median 8, range 1-37). Mean number of positive nodes was 4.8 (median 2, range 0-36). Cancer-specific survival rates at 1, 2 and 3 years of follow-up were 39.3%, 25.0% and 8.6%, respectively. When stratified for nodal status, cancer-specific survival rates at 1, 2 and 3 years of follow-up were 65.0, 36.1, and 9.0% vs. 13.3, 13.0, and 6.7%, for pN0 vs. pN+ cases, respectively (p=0.004). At MVA, after adjusting for all the possible confounders, the num¬ber of positive nodes resulted independently associated with CSM (HR 1.25, p=0.001). Interestingly, at MVA, the number of nodes removed achieved the independent predictor status, as well (HR 0.84, p=0.007) showing a protective effect on survival. The risk of dying increased of 16% every positive node found (p>0.001), and decreased of 8% every node removed (p=0.02) (Table II).  Conclusions: A more extended retroperitoneal lymphadenectomy at the time of nephrectomy statisti¬cally significantly decreased CSM in pT4 cases.
 

Urologia 2012; 79(2): 109 - 115

Article Type: ORIGINAL RESEARCH ARTICLE

DOI:10.5301/RU.2012.9255

Authors

Umberto Capitanio, Rayan Matloob, Nazareno Suardi, Firas Abdollah, Fabio Castiglione, Dario Di Trapani, Andrea Russo, Alberto Briganti, Cristina Carenzi, Andrea Salonia, Francesco Montorsi, Patrizio Rigatti, Roberto Bertini

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Authors

  • Capitanio, Umberto [PubMed] [Google Scholar]
    Department of Urology, University Vita-Salute, San Raffaele Hospital, Milan - Italy
  • Matloob, Rayan [PubMed] [Google Scholar]
    Department of Urology, University Vita-Salute, San Raffaele Hospital, Milan - Italy
  • Suardi, Nazareno [PubMed] [Google Scholar]
    Department of Urology, University Vita-Salute, San Raffaele Hospital, Milan - Italy
  • Abdollah, Firas [PubMed] [Google Scholar]
    Department of Urology, University Vita-Salute, San Raffaele Hospital, Milan - Italy
  • Castiglione, Fabio [PubMed] [Google Scholar]
    Department of Urology, University Vita-Salute, San Raffaele Hospital, Milan - Italy
  • Di Trapani, Dario [PubMed] [Google Scholar]
    Department of Urology, University Vita-Salute, San Raffaele Hospital, Milan - Italy
  • Russo, Andrea [PubMed] [Google Scholar]
    Department of Urology, University Vita-Salute, San Raffaele Hospital, Milan - Italy
  • Briganti, Alberto [PubMed] [Google Scholar]
    Department of Urology, University Vita-Salute, San Raffaele Hospital, Milan - Italy
  • Carenzi, Cristina [PubMed] [Google Scholar]
    Department of Urology, University Vita-Salute, San Raffaele Hospital, Milan - Italy
  • Salonia, Andrea [PubMed] [Google Scholar]
    Department of Urology, University Vita-Salute, San Raffaele Hospital, Milan - Italy
  • Montorsi, Francesco [PubMed] [Google Scholar]
    Department of Urology, University Vita-Salute, San Raffaele Hospital, Milan - Italy
  • Rigatti, Patrizio [PubMed] [Google Scholar]
    Department of Urology, University Vita-Salute, San Raffaele Hospital, Milan - Italy
  • Bertini, Roberto [PubMed] [Google Scholar]
    Department of Urology, University Vita-Salute, San Raffaele Hospital, Milan - Italy

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