Pd04-01 Renal Cell Carcinoma With Isolated Lymph Node Involvement: Natural History and Predictors of Oncologic Outcomes
Year: 2016
Type: article
Study design: Observational Study
Abstract: You have accessJournal of UrologyKidney Cancer: Advanced (including Drug Therapy) II1 Apr 2016PD04-01 RENAL CELL CARCINOMA WITH ISOLATED LYMPH NODE INVOLVEMENT: NATURAL HISTORY AND PREDICTORS OF ONCOLOGIC OUTCOMES Boris Gershman, Daniel Moreira, R. Houston Thompson, Stephen Boorjian, Christine Lohse, Brian Costello, John Cheville, and Bradley Leibovich Boris GershmanBoris Gershman More articles by this author , Daniel MoreiraDaniel Moreira More articles by this author , R. Houston ThompsonR. Houston Thompson More articles by this author , Stephen BoorjianStephen Boorjian More articles by this author , Christine LohseChristine Lohse More articles by this author , Brian CostelloBrian Costello More articles by this author , John ChevilleJohn Cheville More articles by this author , and Bradley LeibovichBradley Leibovich More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2406AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Isolated lymph node (LN) involvement in the absence of systemic disease has historically been associated with a poor prognosis among patients with renal cell carcinoma (RCC). However, a subset of patients may have long-term survival. We examined the natural history of isolated pN1 disease and identified predictors of favorable oncologic outcomes. METHODS Of 3830 patients with M0 RCC treated with partial or radical nephrectomy from 1980 to 2010 at Mayo Clinic, we identified 138 with isolated pN1 disease. All pathology was reviewed by one genitourinary pathologist. Metastasis-free (MFS), cancer-specific (CSS), and overall survival (OS) were estimated using the Kaplan-Meier method. Associations of clinicopathologic features with oncologic outcomes were evaluated using Cox regression models. RESULTS Median number of positive LNs was 2 (IQR 1-3), while 57 (46%) patients had only one positive LN. Overall, 125 (91%) of patients had symptoms at presentation, 60 (43%) had preoperative radiographic lymphadenopathy (cN1), and 106 (77%) had pT3/T4 disease. Median follow-up among survivors was 8.5 years (IQR 5.6-10.9), during which time 108 patients developed distant metastases and 117 died, including 99 from RCC. MFS, CSS, and OS rates at 5/10 years were 16%/15%, 26%/21%, and 25%/15% (Figure). Median time to development of metastases was 4.2 months (IQR 2.1-11.7 months). On multivariable analysis, symptomatic presentation (HR 2.51; p=0.02), radiographic IVC involvement (HR 2.03; p=0.002), pT4 stage (HR 2.56; p=0.006), adverse histologic subtype (HR 2.34; p=0.005), and coagulative tumor necrosis (HR 2.59; p<0.001) were independently associated with development of metastases. Interestingly, the number of positive LNs was not associated with oncologic outcomes. CONCLUSIONS Isolated pN1 disease portends an ominous prognosis, with only 16% of patients free of distant metastases at 5-years after surgery. Nevertheless, this subset does have long-term survival at 10-years. In those patients who progressed, the majority (77%) of metastases occurred within 1 year of surgery. Symptoms at presentation, radiographic IVC involvement, and pT4 stage were independently associated with development of distant metastases and may enhance patient risk stratification and counseling. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e120 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Boris Gershman More articles by this author Daniel Moreira More articles by this author R. Houston Thompson More articles by this author Stephen Boorjian More articles by this author Christine Lohse More articles by this author Brian Costello More articles by this author John Cheville More articles by this author Bradley Leibovich More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
Source: The Journal of Urology
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2315888922