title: Stage-specific effect of nodal metastases on survival in patients with non-metastatic renal cell carcinoma.
abstract: OBJECTIVE
  To quantify the survival disadvantage related to the presence of exclusive nodal metastases (eNM) in patients with otherwise non-metastatic (M0) renal cell carcinoma (RCC).
  
  
  METHODS
  Data were retrieved from 12 institutional databases and yielded 3507 patients with T1-3N1-2M0 RCC treated with partial or radical nephrectomy. Cox regression analyses relied on T stage, Fuhrman grade and presence of eNM. Data were analysed using univariable, multivariable and stratified analyses.
  
  
  RESULTS
  Overall 165 (4.7%) patients had eNM; of 2023 patients of stage T1, 23 (1.1%) had eNM, vs 20 of 448 (4.5%) for T2 and 122 of 993 (12.3%) for T3. In univariable analyses the presence of eNM increased the rate of cancer specific mortality (CSM) by 7.1 times. After adjusting for T stage and Fuhrman grade, in all patients eNM increased the rate of CSM by 3.2 times. In stratified analyses adjusted for Fuhrman grade, the increase in CSM related to the presence of eNM was 28.9, 4.3 and 2.5 times (all P < 0.001) for stages T1, T2 and T3, respectively.
  
  
  CONCLUSIONS
  From the prognostic perspective, staging lymphadenectomy appears of most value in patients with T1-2 RCC, but the low prevalence of eNM questions the practical applicability of nodal staging in those patients. Conversely, in patients with T3 RCC, the prevalence and the prognostic impact of eNM might make a staging lymphadenectomy worthwhile.
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.
authors.forename: Umberto
authors.initials: U
authors.lastname: Capitanio
authors.forename: Claudio
authors.initials: C
authors.lastname: Jeldres
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Patard
authors.forename: Paul
authors.initials: P
authors.lastname: Perrotte
authors.forename: Laurent
authors.initials: L
authors.lastname: Zini
authors.forename: Alexandre
authors.initials: A
authors.lastname: de La Taille
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ficarra
authors.forename: Luca
authors.initials: L
authors.lastname: Cindolo
authors.forename: Karim
authors.initials: K
authors.lastname: Bensalah
authors.forename: Walter
authors.initials: W
authors.lastname: Artibani
authors.forename: Jacques
authors.initials: J
authors.lastname: Tostain
authors.forename: Antoine
authors.initials: A
authors.lastname: Valeri
authors.forename: Richard
authors.initials: R
authors.lastname: Zigeuner
authors.forename: Arnaud
authors.initials: A
authors.lastname: Méjean
authors.forename: Jean Luc
authors.initials: JL
authors.lastname: Descotes
authors.forename: Eric
authors.initials: E
authors.lastname: Lechevallier
authors.forename: Peter F
authors.initials: PF
authors.lastname: Mulders
authors.forename: Herve
authors.initials: H
authors.lastname: Lang
authors.forename: Didier
authors.initials: D
authors.lastname: Jacqmin
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D002648:Child; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods; D011379:Prognosis; D016896:Treatment Outcome; D055815:Young Adult