title: Renal cell carcinoma with nodal metastases in the absence of distant metastatic disease: prognostic indicators of disease-specific survival.
abstract: 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.
authors.affiliation: 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
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
authors.forename: Naeem
authors.initials: N
authors.lastname: Bhojani
authors.forename: Karim
authors.initials: K
authors.lastname: Bensalah
authors.forename: Laurent
authors.initials: L
authors.lastname: Salomon
authors.forename: Alexandre
authors.initials: A
authors.lastname: de la Taille
authors.forename: Jacques
authors.initials: J
authors.lastname: Tostain
authors.forename: Luca
authors.initials: L
authors.lastname: Cindolo
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Altieri
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ficarra
authors.forename: Luigi
authors.initials: L
authors.lastname: Schips
authors.forename: Richard
authors.initials: R
authors.lastname: Zigeuner
authors.forename: Peter F A
authors.initials: PF
authors.lastname: Mulders
authors.forename: Antoine
authors.initials: A
authors.lastname: Valeri
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Descotes
authors.forename: Arnaud
authors.initials: A
authors.lastname: Mejean
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Patard
mesh_terms: 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