For localized T2 to T3 renal cell carcinoma (RCC) patients undergoing radical nephrectomy, lymph node dissection may not provide an additional survival benefit, according to new study results reported during the American Urological Association 2020 Virtual Experience.
Of 43,143 patients with T2-T3 N0 RCC in the National Cancer Database who underwent radical nephrectomy, lymph node dissection was performed in 22%, and 6.7% of these patients were found to harbor positive lymph nodes.
On multivariable analysis, pT2 RCC patients with older age, high grade disease, positive lymph nodes, and increasing Charlson comorbidity index score were significantly associated with 4%, 11%, 190%, and 192% increased risks for all-cause mortality, respectively. In stage pT3 patients, older age, black race, papillary RCC, high-grade disease, negative lymph nodes (but 0 to 4 nodes removed), increasing Charlson comorbidity index score, or positive lymph nodes were significantly associated with 3%, 12%, 17%, 19%, 24%, 109%, and 206% increased risks for all-cause mortality, respectively.
Fady Ghali, MD, of the University of California San Diego School of Medicine, and colleagues identified the following risk factors for significantly worse survival among patients with positive lymph nodes: high grade disease, tumor size larger than 10 cm, clear cell histology, white race, and male sex.
According to Kaplan Meier analyses, pT2 RCC patients with positive lymph nodes had significantly worse median overall survival than patients with negative or indeterminate nodes: 28.5 vs 46.1 vs 44.9 months, respectively. But overall survival did not improve significantly among pT2 patients who underwent lymph node dissection: 45.3 vs 44.9 months without dissection. Survival analyses of pT3 patients likewise showed significantly worse survival among patients with positive vs negative vs indeterminate lymph node status: 23.8 vs 37.4 vs 39.1 months, respectively. Yet patients undergoing lymph dissection displayed significantly worse median overall survival: 36.5 vs 39.1 months without dissection.
The team concluded that lymph node dissection conveys no overall survival benefit in T2 to T3 N0 RCC.
Ghali F, Patel D, Meagher M, et al. Utility and outcomes of lymph node dissection in T2-3 renal cell carcinoma: Analysis of the National Cancer Database. Presented at the American Urological Association 2020 Virtual Experience, May 15-19, 2020. Abstract MP68-04.