title: Node-positive renal cell carcinoma in the absence of distant metastases: predictors of cancer-specific mortality in a population-based cohort.
abstract: Nodal metastases, even in the absence of distant metastases, portend a bad prognosis. The percentage of positive nodes (PPN) represents an important predictor of cancer-specific mortality (CSM) in patients in the group T(any) N(1) M(0) . In consequence, universal inclusion of PPN should be considered in prospective and retrospective CSM analyses.
  
  
  OBJECTIVE
  To examine the outcomes of patients with node-positive renal cell carcinoma (RCC) in the absence of distant metastases in a large population-based cohort of patients To examine the ability of standard risk factors to predict cancer-specific mortality (CSM).
  
  
  METHODS
  Using the Surveillance, Epidemiology, and End Results database, a total of 799 patients with RCC nodal metastases and absence of distant metastases undergoing nephrectomy were identified. Univariable and multivariable analyses was performed with the aim of identifying independent predictors of CSM in this cohort of patients. Specifically, we examined the effect of the number of removed nodes (NRN), the number of positive nodes (NPN) and the percentage of positive nodes (PPN) on CSM.
  
  
  RESULTS
  Actuarial survival estimates showed that 53.2, 37.8 and 25.7% of patients survived at 24, 60 and 120 months after nephrectomy. In Kaplan-Meier analyses, NRN failed to clearly discriminate between recorded CSM rates (log rank P = 0.07). Discrimination was noted when CSM was stratified according to NPN (log rank P = 0.02) and PPN (log rank P = 0.001). In multivariable analyses, age, Fuhrman grade, histological subtype, T stage and PPN were independent predictors of CSM.
  
  
  CONCLUSIONS
  Our data indicate that CSM of patients with exclusive nodal metastases differs according to PPN. Consequently, PPN warrants consideration in future prognostic schemes.
authors: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada. trinh.qd@gmail.com
authors: Quoc-Dien
authors: QD
authors: Trinh
authors: Jan
authors: J
authors: Schmitges
authors: Marco
authors: M
authors: Bianchi
authors: Maxine
authors: M
authors: Sun
authors: Shahrokh F
authors: SF
authors: Shariat
authors: Jesse
authors: J
authors: Sammon
authors: Claudio
authors: C
authors: Jeldres
authors: Kevin
authors: K
authors: Zorn
authors: Shyam
authors: S
authors: Sukumar
authors: Paul
authors: P
authors: Perrotte
authors: Markus
authors: M
authors: Graefen
authors: Craig G
authors: CG
authors: Rogers
authors: James O
authors: JO
authors: Peabody
authors: Mani
authors: M
authors: Menon
authors: Pierre I
authors: PI
authors: Karakiewicz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality* / Q000601:surgery; D008197:Lymph Node Excision / Q000401:mortality; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000401:mortality; D011379:Prognosis; D012042:Registries; D014481:United States / Q000453:epidemiology; D055815:Young Adult