Renal cell carcinoma with nodal metastases in the absence of distant metastatic disease: prognostic indicators of disease-specific survival.
OBJECTIVE
Outcome of patients with exclusive renal cell carcinoma (RCC) nodal metastases without distant metastases is not extensively described. We explored the ability of standard risk factors such as tumour size, Fuhrman grade, histologic subtype and symptom classification to predict renal cell carcinoma-specific survival (RCC-SS).


METHODS
Analyses targeted 171 patients with RCC nodal metastases and absence of distant metastases. Univariable, multivariable, and predictive accuracy analyses addressed RCC-SS with the intent of identifying independent and most informative predictors of RCC-SS in this cohort of patients.


RESULTS
Median RCC-SS was 2.3 yr. Symptom classification (61.3%, p<0.001) demonstrated the highest univariable accuracy. In multivariable analyses, symptom classification contributed the most to the combined predictive accuracy of all variables (+4.2%, p<0.001), followed by Fuhrman grade (+2.3%) and histologic subtype (+1.0%).


CONCLUSIONS
Renal cell carcinoma-specific survival of patients with exclusive nodal metastases may show important variability. In presence of systemic symptoms, survival is extremely poor. Substantially better survival may be expected in patients with local or no symptoms. This observation has important implications when adjuvant therapies are considered.
Karakiewicz
Pierre I
PI
Cancer Prognostics and Health Outcome Unit, University of Montreal Health Center, Montreal, Quebec, Canada, and Department of Urology, Rennes University Hospital, France. pierre.karakiewicz@umontreal.ca
Trinh
Quoc-Dien
QD
Bhojani
Naeem
N
Bensalah
Karim
K
Salomon
Laurent
L
de la Taille
Alexandre
A
Tostain
Jacques
J
Cindolo
Luca
L
Altieri
Vincenzo
V
Ficarra
Vincenzo
V
Schips
Luigi
L
Zigeuner
Richard
R
Mulders
Peter F A
PF
Valeri
Antoine
A
Descotes
Jean-Luc
JL
Mejean
Arnaud
A
Patard
Jean-Jacques
JJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009392:Nephrectomy / Q000379:methods; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D016019:Survival Analysis