Patients who have renal cell carcinoma (RCC) with isolated lymph node (LN) involvement have a poor prognosis following surgical resection, with 5-year survival rates less than 30%, according to a new study of a contemporary cohort.

Using the National Cancer Database, a team led by Boris Gershman, MD, of Beth Israel Deaconess Medical Center in Boston, and colleagues studied 2679 patients who underwent nephrectomy for RCC with isolated lymph node metastases from 2006 to 2013. Of these, 1782 died during a median follow-up period of 19.2 months. The 1-, 5-, and 8-year overall survival (OS) rates were 68%, 28%, and 19%, respectively, the investigators reported in Urologic Oncology.

Results suggest that contemporary survival rates for these patients have not improved dramatically compared with earlier studies, according to the investigators.

On multivariable analysis, older age, rural location, larger tumor size, higher pathologic T stage, positive surgical margins, number of positive LNs, and nonclear cell histologic subtype were independently associated with worse OS. Patients aged 70 years or older had a 50% increased risk of death compared with those aged 18 or older but younger than 50 years. Compared with patients who lived in metropolitan areas, those in rural areas had a significant 49% increased risk of death. Positive vs negative surgical margins were significantly associated with a 55% increased risk of death.

Death risk increased significantly along with tumor size. Compared with tumors smaller than 5 cm, tumors 5 cm or larger but less than 10 cm were associated with a 29% increased risk of death. Tumors 10 cm or larger but less than 15 cm and tumors 15 cm or larger were associated with a 34% and 43% increased risk of death, respectively, Dr Gershman and his colleagues reported.

In addition, the more positive LNs patients had, the greater their death risk. Patients with 2 to 3 and more than 3 positive LNs had a significant 18% and 37% increased death risk, respectively, compared with patients who had 1 positive LN.

Compared with patients who had pT1 disease, those with pT3 and pT4 disease had a significant 25% and 241% increased risk of death, respectively.

Nonclear cell histologic subtype was associated with a significant 32% increased risk of death compared with clear cell histologic subtype.

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Dr Gershman’s team developed a simplified risk score to facilitate postoperative prognostication and selection of patients for consideration of adjuvant treatment and clinical trial enrollment. The risk score is based on the variables independently associated with increased death risk, with the presence or absence of each variable assigned a point value. Points are added up to arrive at a risk score, which is used to predict survival over time.

Reference

Golijanin B, Pereira J, Mueller-Leonhard C, et al. The natural history of renal cell carcinoma with isolated lymph node metastases following surgical resection from 2006 to 2013 [published online September 27, 2019]. Urol Oncol. doi: 10.1016/j.urolonc.2019.08.003