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Kidney Cancer
Renal Cell Carcinoma with Isolated Lymph Node Involvement:
Long-term Natural History and Predictors of Oncologic Outcomes
Following Surgical Resection
Boris Gershman
a ,Daniel M. Moreira
b ,R. Houston Thompson
c ,Stephen A. Boorjian
c ,Christine M. Lohse
d ,Brian A. Costello
e ,John C. Cheville
f ,Bradley C. Leibovich
c , *a
Division of Urology, Rhode Island Hospital and The Miriam Hospital, Providence, RI, USA;
b
Department of Urology, University of Illinois, Chicago, IL, USA;
c
Department of Urology, Mayo Clinic, Rochester, MN, USA;
d
Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA;
e
Department of
Oncology, Mayo Clinic, Rochester, MN, USA;
f
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
E U R O P E A N U R O L O G Y 7 2 ( 2 0 1 7 ) 3 0 0 – 3 0 6available at
www.scienced irect.comjournal homepage:
www.europeanurology.comArticle info
Article history:
Accepted December 23, 2016
Associate Editor:
Giacomo Novara
Keywords:
Renal cell carcinoma
Lymph nodes
Nephrectomy
Natural history
Survival
Abstract
Background:
Renal cell carcinoma (RCC) with isolated lymph node (LN) involvement
has historically been associated with poor prognosis. However, a subset of patients may
experience long-term survival.
Objective:
To examine the natural history of RCC with isolated LN involvement follow-
ing surgical resection with long-term follow-up, and to evaluate clinicopathologic
features associated with disease progression and survival.
Design, setting, and participants:
A total of 138 patients with isolated pN1M0 RCC
underwent partial or radical nephrectomy and LN dissection from 1980 to 2010.
Intervention:
Partial or radical nephrectomy with LN dissection.
Outcome measurements and statistical analysis:
Metastasis-free survival (MFS), cancer-
specific survival (CSS), and overall survival (OS) were estimated using the Kaplan-Meier
method. Associations between clinicopathologic features and oncologic outcomes were
evaluated using Cox regression models.
Results and limitations:
Median follow-up among survivors was 8.5 yr. The 5-yr and 10-
yr MFS, CSS, and OS rates were 16% and 15%, 26% and 21%, and 25% and 15%, respectively.
The median time to development of metastases was only 4.2 mo. On multivariable
analysis, symptoms at presentation (hazard ratio [HR] 2.40;
p
= 0.03), inferior vena cava
tumor thrombus (HR 1.99;
p
= 0.003), clear cell (HR 2.21;
p
= 0.01) and collecting duct/
not otherwise specified (HR 4.28;
p
<
0.001) histologic subtypes, pT4 stage (HR 2.64;
p
= 0.005), and coagulative tumor necrosis (HR 2.51;
p
<
0.001) were independently
associated with development of metastases. MFS rates at 1 yr after surgery were 71%,
63%, 33%, and 7% for patients with one, two, three, and four to five adverse features,
respectively. Limitations include surgical selection bias.
Conclusions:
Although isolated pN1 disease portends
[5_TD$DIFF]
a poor prognosis, a small subset of
patients experience durable long-term survival after surgical resection of isolated
lymphatic metastases. Adverse prognostic features may enhance patient risk stratifica-
tion and facilitate multimodal management approaches.
Patient summary:
Although isolated lymph node metastases portend
[6_TD$DIFF]
a poor prognosis,
a small subset of patients experience long-term survival following surgical resection.
#
2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.
* Corresponding author. Department of Urology, Mayo Clinic, 200 First Street SW, Rochester, MN
55905, USA. Tel. +1 507 2660191; Fax: +1 507 2844951.
E-mail address:
leibovich.bradley@mayo.edu(B.C. Leibovich).
http://dx.doi.org/10.1016/j.eururo.2016.12.0270302-2838/
#
2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.