Lymph node dissection during cytoreductive nephrectomy: A retrospective analysis Journal Article

   


Authors: Feuerstein, M. A.; Kent, M.; Bernstein, M.; Russo, P.
Article Title: Lymph node dissection during cytoreductive nephrectomy: A retrospective analysis
Abstract: Objective: To assess whether regional lymph node dissection could improve the prognosis of patients with metastatic renal cell carcinoma. Methods: We reviewed data on 258 patients who underwent cytoreductive nephrectomy at Memorial Sloan Kettering Cancer Center, New York, USA, some of whom received a concurrent lymph node dissection. The primary outcome measure was overall survival. A Cox proportional hazards regression model included, age, pathological stage, lymphadenopathy, tumor size, modified Memorial Sloan Kettering Cancer Center criteria, site of metastatic disease and lymph node dissection. We created a logistic regression model to evaluate risk factors for node-positive disease. Survival analyses were carried out for lymph node template (hilar vs other) and number of nodes removed (0-3, 4-7 or ≥8). Results: Of 258 patients, 177 (69%) underwent lymph node dissection, and positive nodes were found in 59 (33%). The 5-year overall survival was 21% for patients who underwent lymph node dissection and 31% for patients who did not. No significant difference in survival was found among patients receiving or not receiving lymph node dissection. The 5-year overall survival was 27% and 9% for negative and positive nodal status, respectively (P<0.0005). For patients who underwent lymph node dissection, the presence of lymphadenopathy was a significant predictor of node-positive disease (odds ratio 25.0, 95% confidence interval 9.04-69.4, P<0.0001). Conclusions: Lymph node dissection carried out during cytoreductive nephrectomy is not associated with a survival benefit. Lymph node-positive disease represents a poor prognostic variable; therefore, lymph node dissection should be considered as a staging procedure for clinical trials. © 2014 The Japanese Urological Association.
Keywords: adult; cancer survival; controlled study; aged; middle aged; major clinical study; overall survival; united states; outcome assessment; follow up; lymph node dissection; cytoreductive surgery; retrospective study; risk factor; histology; nephrectomy; proportional hazards model; partial nephrectomy; lymph node; cancer size; carcinoma; kaplan meier method; kidney metastasis; lymphadenopathy; metastatic; renal cell; cytoreductive nephrectomy; cancer prognosis; human; male; female; priority journal; article
Journal Title: International Journal of Urology
Volume: 21
Issue: 9
ISSN: 0919-8172
Publisher: Wiley Blackwell  
Date Published: 2014-09-01
Start Page: 874
End Page: 879
Language: English
DOI: 10.1111/iju.12457
PROVIDER: scopus
PMCID: PMC4146659
PUBMED: 24712686
DOI/URL:

http://www.scopus.com/inward/record.url?eid=2-s2.0-84906934914&partnerID=40&md5=c627a33c50057e0ffe25a6d82ba76ad8
Notes: Export Date: 1 October 2014 -- Source: Scopus
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MSK Authors
  1. Paul Russo
    581 Russo
  2. Melanie Bernstein
    62 Bernstein
  3. Michael Adam Feuerstein
    11 Feuerstein
  4. Matthew T Kent
    26 Kent
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