title: Lymphadenopathies in patients with renal cell carcinoma: clinical and pathological predictors of pathologically confirmed lymph node invasion.
abstract: BACKGROUND
  In renal cell carcinoma (RCC), lymph node status at preoperative imaging is affected by a non-negligible false-positive rate. We aimed to investigate which factors are related to a concordance between clinical suspicion and pathological confirmation of lymph node invasion (LNI).
  
  
  METHODS
  At a single tertiary care institution, 2954 RCC patients underwent either partial or radical nephrectomy. For the aim of the study, only clinically positive lymph node cases were included (cN1). Statistical analyses assessed the concordance between preoperative and pathological nodal status.
  
  
  RESULTS
  Preoperative axial CT scans revealed 424 (14.4 %) patients showing at least one enlarged lymph node suspected for LNI (cN1). All lymphadenopathies were removed at surgery, and LNI was pathologically confirmed (pN1) in 122 patients (28.8 %). When focusing the analyses on clinical characteristics (variables known before surgery), metastases at diagnosis [OR 3.0 (95 %1.9-4.8), p < 0.001] and tumor size [OR 1.1 (95 % 1.1-1.2), p < 0.001] were the two most informative predictors of concordance between clinical and pathological nodal status. Concordance was also more likely in patients with papillary type II tumors (55.6 %) relative to papillary type I (38.1 %), clear cell (27.7 %) and chromophobe (8.3 %) tumors. At multivariable analyses, none of the considered blood markers resulted to be independently associated with LNI.
  
  
  CONCLUSIONS
  Roughly 70 % of patients showing a suspected lymph node preoperatively do not show LNI at the final pathological report. Among patients with clinically positive nodes, clinical tumor size and metastases at diagnosis represent the most informative and independent predictors of confirmed LNI at final pathology.
authors.affiliation: Unit of Urology, University Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy. umbertocapitanio@gmail.com.|Division of Experimental Oncology, URI, Urological Research Institute, Renal Cancer Unit, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy. umbertocapitanio@gmail.com.
authors.forename: Umberto
authors.initials: U
authors.lastname: Capitanio
authors.affiliation: Unit of Urology, University Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Deho'
authors.affiliation: Unit of Urology, University Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy.|Division of Experimental Oncology, URI, Urological Research Institute, Renal Cancer Unit, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Dell'Oglio
authors.affiliation: Unit of Urology, University Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy.|Division of Experimental Oncology, URI, Urological Research Institute, Renal Cancer Unit, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Larcher
authors.affiliation: Unit of Urology, University Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy.|Division of Experimental Oncology, URI, Urological Research Institute, Renal Cancer Unit, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Capogrosso
authors.affiliation: Unit of Urology, University Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy.|Division of Experimental Oncology, URI, Urological Research Institute, Renal Cancer Unit, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Nini
authors.affiliation: Division of Experimental Oncology, URI, Urological Research Institute, Renal Cancer Unit, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Carenzi
authors.affiliation: Department of Pathology, University Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Freschi
authors.affiliation: Unit of Urology, University Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy.|Division of Experimental Oncology, URI, Urological Research Institute, Renal Cancer Unit, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.affiliation: Unit of Urology, University Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy.|Division of Experimental Oncology, URI, Urological Research Institute, Renal Cancer Unit, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Salonia
authors.affiliation: Unit of Urology, University Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy.|Division of Experimental Oncology, URI, Urological Research Institute, Renal Cancer Unit, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.affiliation: Unit of Urology, University Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Bertini
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000556:secondary*; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology*; D000072281:Lymphadenopathy / Q000209:etiology* / Q000473:pathology; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011379:Prognosis
keywords: Lymph node dissection; Lymph node invasion; Lymphadenectomy; Renal cell carcinoma