title: The prognostic relevance of interactions between venous invasion, lymph node involvement and distant metastases in renal cell carcinoma after radical nephrectomy.
abstract: BACKGROUND
  To investigate a possible prognostic significance of interactions between lymph node invasion (LNI), synchronous distant metastases (SDM), and venous invasion (VI) adjusted for mode of detection, Eastern Cooperative Oncology Group performance status (ECOG PS), erythrocyte sedimentation rate (ESR) and tumour size (TS) in 196 patients with renal cell carcinoma treated with radical nephrectomy.
  
  
  METHODS
  Median follow-up was 5.5 years (mean 6.9 years; range 0.01-19.4). The mode of detection, ECOG PS, ESR and TS were obtained from the patients' records. Vena cava invasion and distant metastases were detected by preoperative imaging. The surgical specimens were examined for pathological stage, LNI and VI.
  
  
  RESULTS
  The univariate analyses showed significant impact of VI, LNI, SDM, ESR and TS (p < 0.001), as well as mode of detection (p = 0.003) and ECOG PS (p = 0.002) on cancer specific survival. In multivariate analyses LNI was significantly associated with survival only in patients without SDM or VI (p < 0.001) with a hazard ratio of 9.0. LNI lost its prognostic significance when SDM or VI was present.
  
  
  CONCLUSIONS
  Our findings underline the prognostic importance of the status of the lymph nodes. LNI, SDM, ESR, and VI were independently associated with cancer specific survival after radical nephrectomy. LNI provided the strongest prognostic information for patients without SDM or VI whereas SDM and VI had strongest impact on survival when there was no nodal involvement.
authors.affiliation: Department of Surgical Sciences, University of Bergen, Norway. zubac.dragomir2423@gmail.com
authors.forename: Dragomir P
authors.initials: DP
authors.lastname: Zubac
authors.forename: Leif
authors.initials: L
authors.lastname: Bostad
authors.forename: Tomas
authors.initials: T
authors.lastname: Seidal
authors.forename: Tore
authors.initials: T
authors.lastname: Wentzel-Larsen
authors.forename: Svein A
authors.initials: SA
authors.lastname: Haukaas
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging / Q000379:methods; D009392:Nephrectomy / Q000401:mortality / Q000639:trends; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D019043:Vascular Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000556:secondary* / Q000601:surgery