Lymphadenectomy Offers No Survival Benefit in Nonmetastatic RCC

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Lymph node dissection does not influence overall survival in patients with nonmetastatic renal cell carcinoma, even among patients with clinically positive nodal disease.
Lymph node dissection does not influence overall survival in patients with nonmetastatic renal cell carcinoma, even among patients with clinically positive nodal disease.

Lymph node dissection (LND) in patients with nonmetastatic renal cell carcinoma (RCC) has no significant impact on overall survival, new study findings suggest. In addition, LND often is performed for low-stage disease, suggesting possible overuse of the procedure.

The study included 11,867 patients from the National Cancer Database who underwent nephrectomy (partial or radical) for nonmetastatic RCC and LND from 2010 to 2014.

Among the 11,867 patients who underwent LND, 5%, 23%, 31%, and 47% had clinical T stage 1, 2, 3, and 4 tumors, respectively, according to the investigators. The proportions of patients who underwent LND did not change significantly during 2010 to 2014. “Our study would seem to suggest that there currently is an overutilization of LND for patients with lower stage disease,” they wrote.

To minimize selection bias, 9750 patients who received LND were propensity score matched to 9750 controls who underwent nephrectomy but not LND. Median overall survival (OS) was 34.7 months in the LND group and 34.9 months in the no-LND group, a nonsignificant difference, first author Nicholas J. Farber, MD, Chief Resident in Urology at Rutgers Robert Wood Johnson Medical School (RWJMS), and colleagues reported in Urologic Oncology. The study also found no significant difference in median OS between LND and no LND among patients with clinically positive lymph nodes (36.7 and 35.1 months, respectively). The number of lymph nodes removed and exposure to neoadjuvant or adjuvant therapy did not change this finding.

The team, led by Eric A. Singer, MD, MA, of the Rutgers Cancer Institute of New Jersey and RWJMS, noted: “With the recent FDA approval of novel immunologic treatments and an adjuvant targeted therapy it may be reasonable to consider LND for the purpose of staging and to help guide future therapeutic choices”.

Reference

Farber NJ, Rivera-Nunez Z, Kim S, et al. Trends and outcomes of lymphadenectomy for nonmetastatic renal cell carcinoma: A propensity score-weighted analysis of the National Cancer Database. Urol Oncol. 2018; published online ahead of print.

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