Radical Nephrectomy With or Without Lymph Node Dissection for Nonmetastatic Renal Cell Carcinoma: A Propensity Score-based Analysis.
It is uncertain whether lymph node dissection (LND) provides a therapeutic benefit in renal cell carcinoma (RCC).



To evaluate the association of LND with oncologic outcomes among patients undergoing radical nephrectomy (RN) for nonmetastatic RCC.



A retrospective cohort study of 1797 patients treated with RN for M0 RCC between 1990 and 2010, including 606 (34%) who underwent LND.



RN with or without LND.



The associations of LND with the development of distant metastases, cancer-specific mortality (CSM), and all-cause mortality (ACM) were evaluated using 1:1 propensity score (PS) matching, adjustment for/stratification by PS quintile, and inverse probability weighting. Cox models were used to evaluate the association of the number of lymph nodes removed with oncologic outcomes.



A total of 111 (6.2%) patients were pN1. The median follow-up after surgery was 10.6 yr. Following PS adjustment, there were no significant differences in clinicopathologic features between patients with and without LND. In the overall cohort, LND was not significantly associated with a reduced risk of distant metastases, CSM, or ACM. Moreover, LND was not associated with improved oncologic outcomes even among patients at increased risk of pN1 disease, including those with preoperative radiographic lymphadenopathy, or across increasing threshold probabilities for pN1 disease from 0.05 to 0.50. Among patients who underwent LND, the extent of LND was not significantly associated with the development of distant metastases, CSM, or ACM. Limitations include the retrospective design.



We did not identify an oncologic benefit to LND in the overall cohort or among patients at increased risk of nodal disease. These findings do not support a therapeutic benefit to LND in patients with M0 RCC.



Lymph node dissection does not appear to provide a therapeutic benefit in patients with nonmetastatic renal cell carcinoma.
Division of Urology, Rhode Island Hospital and The Miriam Hospital, Providence, RI, USA.
Boris
B
Gershman
Department of Urology, Mayo Clinic, Rochester, MN, USA.
R Houston
RH
Thompson
Department of Urology, University of Illinois at Chicago, Chicago, IL, USA.
Daniel M
DM
Moreira
Department of Urology, Mayo Clinic, Rochester, MN, USA.
Stephen A
SA
Boorjian
Department of Urology, Mayo Clinic, Rochester, MN, USA.
Matthew K
MK
Tollefson
Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
Christine M
CM
Lohse
Department of Oncology, Mayo Clinic, Rochester, MN, USA.
Brian A
BA
Costello
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
John C
JC
Cheville
Department of Urology, Mayo Clinic, Rochester, MN, USA. Electronic address: Leibovich.Bradley@mayo.edu.
Bradley C
BC
Leibovich
D000293:Adolescent; D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
Lymph node dissection; Lymphadenopathy; Nephrectomy; Renal cell carcinoma; Survival