title: Radical Nephrectomy for Renal Cell Carcinoma:  Its Contemporary Role Related to Histologic Type, Tumor Size, and Nodal Status: A Retrospective Study.
abstract: OBJECTIVE
  Staging for renal cell carcinoma (RCC) depends on tumor size and the status of the regional lymph nodes. Although lymph node involvement by tumor yields the most accurate staging and prognostic information in patients with carcinomas of various genitourinary organs, the role of lymph node sampling (LNS) in patients with RCC to definitively establish nodal metastases remains unsettled.
  
  
  METHODS
  In this retrospective study of 399 patients with RCC treated by total nephrectomy, 115 cases were subjected to lymph node dissection.
  
  
  RESULTS
  The corresponding primary tumors averaged  larger than 8 cm. Twenty-nine showed positive lymph nodes (25%). The present review confirms that primary tumor size is a key indicator of nodal involvement. Clear cell and papillary tumors larger than 4 cm involve lymph nodes more commonly than other types of RCC. Sarcomatoid differentiation occurred in all major cell types and existed in numbers too few to predict the likelihood of nodal metastases.
  
  
  CONCLUSIONS
  LNS in RCC for staging purposes may be warranted based on tumor size (>4 cm) as determined by imaging as well as histologic cell type, the latter suggesting a selective role for preoperative fine needle aspiration or core biopsy.
authors.affiliation: Department of Pathology, the University of Chicago Medicine, Chicago, IL.
authors.forename: Kamran M
authors.initials: KM
authors.lastname: Mirza
authors.affiliation: Department of Pathology, the University of Chicago Medicine, Chicago, IL.
authors.forename: Jerome B
authors.initials: JB
authors.lastname: Taxy
authors.affiliation: Department of Pathology, the University of Chicago Medicine, Chicago, IL. tatjana.antic@uchospitals.edu.
authors.forename: Tatjana
authors.initials: T
authors.lastname: Antic
mesh_terms: D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D009392:Nephrectomy; D012189:Retrospective Studies
keywords: Lymph node dissection; Renal cell carcinoma