Lymphadenectomy improves survival of patients with renal cell carcinoma and nodal metastases

Jared M Whitson, Catherine R. Harris, Adam C. Reese, Maxwell V. Meng

Research output: Contribution to journalArticle

72 Citations (Scopus)

Abstract

Purpose: In a population based cohort we determined whether an increase in the number of lymph nodes removed is associated with improved disease specific survival of patients with renal cell carcinoma treated with nephrectomy. Materials and Methods: Patients in the Surveillance, Epidemiology and End Results database with renal cell carcinoma and no evidence of distant metastases were identified. Those patients included in the study underwent radical or partial nephrectomy with lymphadenectomy. Cox regression analyses were performed to identify factors associated with disease specific survival including an interaction between lymph node status and the number of lymph nodes removed. Results: Between 1988 and 2006, 9,586 patients with renal cell carcinoma met the study inclusion criteria. Median followup was 3.5 years (range 1.4 to 6.8). Of the patients 2,382 (25%) died of renal cell carcinoma, including 1,646 (20%) with lymph node negative disease and 736 (58%) with lymph node positive disease. There was no effect on disease specific survival with increasing the extent of lymphadenectomy in patients with negative lymph nodes (HR 1.0, 95% CI 0.91.1, p = 0.93). However, patients with positive lymph nodes had increased disease specific survival with extent of lymphadenectomy (HR 0.8 per 10 lymph nodes removed, 95% CI 0.71.0, p = 0.04). An increase of 10 lymph nodes in a patient with 1 positive lymph node was associated with a 10% absolute increase in disease specific survival at 5 years (p = 0.004). Conclusions: This study shows an association between increased lymph node yield and improved disease specific survival of patients with lymph node positive nonmetastatic renal cell carcinoma who underwent lymphadenectomy. Patients at high risk for nodal disease should be considered for regional or extended lymphadenectomy. Clinical variables to predict risk and validation of dissection templates are important areas for future research.

Original languageEnglish (US)
Pages (from-to)1615-1620
Number of pages6
JournalJournal of Urology
Volume185
Issue number5
DOIs
StatePublished - May 2011
Externally publishedYes

Fingerprint

Lymph Node Excision
Renal Cell Carcinoma
Lymph Nodes
Neoplasm Metastasis
Survival
Nephrectomy
Dissection
Epidemiology
Regression Analysis
Databases

Keywords

  • carcinoma
  • lymph node excision
  • nephrectomy
  • renal cell
  • survival

ASJC Scopus subject areas

  • Urology

Cite this

Lymphadenectomy improves survival of patients with renal cell carcinoma and nodal metastases. / Whitson, Jared M; Harris, Catherine R.; Reese, Adam C.; Meng, Maxwell V.

In: Journal of Urology, Vol. 185, No. 5, 05.2011, p. 1615-1620.

Research output: Contribution to journalArticle

Whitson, Jared M ; Harris, Catherine R. ; Reese, Adam C. ; Meng, Maxwell V. / Lymphadenectomy improves survival of patients with renal cell carcinoma and nodal metastases. In: Journal of Urology. 2011 ; Vol. 185, No. 5. pp. 1615-1620.
@article{4c829d4eb9ba41cface040dbf2fee22e,
title = "Lymphadenectomy improves survival of patients with renal cell carcinoma and nodal metastases",
abstract = "Purpose: In a population based cohort we determined whether an increase in the number of lymph nodes removed is associated with improved disease specific survival of patients with renal cell carcinoma treated with nephrectomy. Materials and Methods: Patients in the Surveillance, Epidemiology and End Results database with renal cell carcinoma and no evidence of distant metastases were identified. Those patients included in the study underwent radical or partial nephrectomy with lymphadenectomy. Cox regression analyses were performed to identify factors associated with disease specific survival including an interaction between lymph node status and the number of lymph nodes removed. Results: Between 1988 and 2006, 9,586 patients with renal cell carcinoma met the study inclusion criteria. Median followup was 3.5 years (range 1.4 to 6.8). Of the patients 2,382 (25{\%}) died of renal cell carcinoma, including 1,646 (20{\%}) with lymph node negative disease and 736 (58{\%}) with lymph node positive disease. There was no effect on disease specific survival with increasing the extent of lymphadenectomy in patients with negative lymph nodes (HR 1.0, 95{\%} CI 0.91.1, p = 0.93). However, patients with positive lymph nodes had increased disease specific survival with extent of lymphadenectomy (HR 0.8 per 10 lymph nodes removed, 95{\%} CI 0.71.0, p = 0.04). An increase of 10 lymph nodes in a patient with 1 positive lymph node was associated with a 10{\%} absolute increase in disease specific survival at 5 years (p = 0.004). Conclusions: This study shows an association between increased lymph node yield and improved disease specific survival of patients with lymph node positive nonmetastatic renal cell carcinoma who underwent lymphadenectomy. Patients at high risk for nodal disease should be considered for regional or extended lymphadenectomy. Clinical variables to predict risk and validation of dissection templates are important areas for future research.",
keywords = "carcinoma, lymph node excision, nephrectomy, renal cell, survival",
author = "Whitson, {Jared M} and Harris, {Catherine R.} and Reese, {Adam C.} and Meng, {Maxwell V.}",
year = "2011",
month = "5",
doi = "10.1016/j.juro.2010.12.053",
language = "English (US)",
volume = "185",
pages = "1615--1620",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Lymphadenectomy improves survival of patients with renal cell carcinoma and nodal metastases

AU - Whitson, Jared M

AU - Harris, Catherine R.

AU - Reese, Adam C.

AU - Meng, Maxwell V.

PY - 2011/5

Y1 - 2011/5

N2 - Purpose: In a population based cohort we determined whether an increase in the number of lymph nodes removed is associated with improved disease specific survival of patients with renal cell carcinoma treated with nephrectomy. Materials and Methods: Patients in the Surveillance, Epidemiology and End Results database with renal cell carcinoma and no evidence of distant metastases were identified. Those patients included in the study underwent radical or partial nephrectomy with lymphadenectomy. Cox regression analyses were performed to identify factors associated with disease specific survival including an interaction between lymph node status and the number of lymph nodes removed. Results: Between 1988 and 2006, 9,586 patients with renal cell carcinoma met the study inclusion criteria. Median followup was 3.5 years (range 1.4 to 6.8). Of the patients 2,382 (25%) died of renal cell carcinoma, including 1,646 (20%) with lymph node negative disease and 736 (58%) with lymph node positive disease. There was no effect on disease specific survival with increasing the extent of lymphadenectomy in patients with negative lymph nodes (HR 1.0, 95% CI 0.91.1, p = 0.93). However, patients with positive lymph nodes had increased disease specific survival with extent of lymphadenectomy (HR 0.8 per 10 lymph nodes removed, 95% CI 0.71.0, p = 0.04). An increase of 10 lymph nodes in a patient with 1 positive lymph node was associated with a 10% absolute increase in disease specific survival at 5 years (p = 0.004). Conclusions: This study shows an association between increased lymph node yield and improved disease specific survival of patients with lymph node positive nonmetastatic renal cell carcinoma who underwent lymphadenectomy. Patients at high risk for nodal disease should be considered for regional or extended lymphadenectomy. Clinical variables to predict risk and validation of dissection templates are important areas for future research.

AB - Purpose: In a population based cohort we determined whether an increase in the number of lymph nodes removed is associated with improved disease specific survival of patients with renal cell carcinoma treated with nephrectomy. Materials and Methods: Patients in the Surveillance, Epidemiology and End Results database with renal cell carcinoma and no evidence of distant metastases were identified. Those patients included in the study underwent radical or partial nephrectomy with lymphadenectomy. Cox regression analyses were performed to identify factors associated with disease specific survival including an interaction between lymph node status and the number of lymph nodes removed. Results: Between 1988 and 2006, 9,586 patients with renal cell carcinoma met the study inclusion criteria. Median followup was 3.5 years (range 1.4 to 6.8). Of the patients 2,382 (25%) died of renal cell carcinoma, including 1,646 (20%) with lymph node negative disease and 736 (58%) with lymph node positive disease. There was no effect on disease specific survival with increasing the extent of lymphadenectomy in patients with negative lymph nodes (HR 1.0, 95% CI 0.91.1, p = 0.93). However, patients with positive lymph nodes had increased disease specific survival with extent of lymphadenectomy (HR 0.8 per 10 lymph nodes removed, 95% CI 0.71.0, p = 0.04). An increase of 10 lymph nodes in a patient with 1 positive lymph node was associated with a 10% absolute increase in disease specific survival at 5 years (p = 0.004). Conclusions: This study shows an association between increased lymph node yield and improved disease specific survival of patients with lymph node positive nonmetastatic renal cell carcinoma who underwent lymphadenectomy. Patients at high risk for nodal disease should be considered for regional or extended lymphadenectomy. Clinical variables to predict risk and validation of dissection templates are important areas for future research.

KW - carcinoma

KW - lymph node excision

KW - nephrectomy

KW - renal cell

KW - survival

UR - http://www.scopus.com/inward/record.url?scp=79953772275&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79953772275&partnerID=8YFLogxK

U2 - 10.1016/j.juro.2010.12.053

DO - 10.1016/j.juro.2010.12.053

M3 - Article

C2 - 21419453

AN - SCOPUS:79953772275

VL - 185

SP - 1615

EP - 1620

JO - Journal of Urology

JF - Journal of Urology

SN - 0022-5347

IS - 5

ER -