Impact of lymph node dissection at the time of radical nephrectomy with tumor thrombectomy on oncological outcomes: Results from the International Renal Cell Carcinoma-Venous Thrombus Consortium (IRCC-VTC)
To study the effect of lymph node dissection (LND) at the time of nephrectomy and tumor thrombectomy on oncological outcomes in patients with renal cell carcinoma (RCC) and tumor thrombus. The records of 1,978 patients with RCC and tumor thrombus who underwent radical nephrectomy and tumor thrombect...
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| Veröffentlicht in: | Urologic oncology 2018-02, Vol.36 (2), p.79.e11-79.e17 |
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| creator | Tilki, Derya Chandrasekar, Thenappan Capitanio, Umberto Ciancio, Gaetano Daneshmand, Siamak Gontero, Paolo Gonzalez, Javier Haferkamp, Axel Hohenfellner, Markus Huang, William C. Linares Espinós, Estefania Lorentz, Adam Martinez-Salamanca, Juan I. Master, Viraj A. McKiernan, James M. Montorsi, Francesco Novara, Giacomo Pahernik, Sascha Palou, Juan Pruthi, Raj S. Rodriguez-Faba, Oscar Russo, Paul Scherr, Douglas S. Shariat, Shahrokh F. Spahn, Martin Terrone, Carlo Vera-Donoso, Cesar Zigeuner, Richard Libertino, John A. Evans, Christopher P. |
| description | To study the effect of lymph node dissection (LND) at the time of nephrectomy and tumor thrombectomy on oncological outcomes in patients with renal cell carcinoma (RCC) and tumor thrombus.
The records of 1,978 patients with RCC and tumor thrombus who underwent radical nephrectomy and tumor thrombectomy from 1985 to 2014 at 24 centers were analyzed. None of the patients had distant metastases. Extent and pathologic results of LND were compared with respect to cancer-specific survival (CSS). Multivariable Cox regression models were used to quantify the effect of multiple covariates.
LND was performed in 1,026 patients. In multivariable analysis, the presence of LN metastasis, the number of positive LNs, and LN density were independently associated with cancer-specific mortality (CSM). Clinical node-negative (cN−) disease was documented in 573 patients, 447 of them underwent LND with 43 cN− patients (9.6%) revealing positive LNs at pathology. LN positive cN− patients showed significantly better CSS when compared to LN positive cN+ patients. In multivariable analysis, positive cN status in LN positive patients was a significant predictor of CSM (HR, 2.923; P = 0.015).
The number of positive nodes harvested during LND and LN density was strong prognostic indicators of CSS, while number of removed LNs did not have a significant effect on CSS. The rate of pN1 patients among clinically node-negative patients was relatively high, and LND in these patients suggested a survival benefit. However, only a randomized trial can determine the absolute benefit of LND in this setting.
•RCC patients with tumor thrombus are pT3 by definition; they are at high-risk.•Analysis of the largest multi-institutional RCC tumor thrombus database (IRCC-VTC).•9.6% of clinically node-negative patients were pathologically node-positive.•cN0/pN1 had better CSS when compared to cN1/pN1. |
| doi_str_mv | 10.1016/j.urolonc.2017.10.008 |
| format | Article |
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The records of 1,978 patients with RCC and tumor thrombus who underwent radical nephrectomy and tumor thrombectomy from 1985 to 2014 at 24 centers were analyzed. None of the patients had distant metastases. Extent and pathologic results of LND were compared with respect to cancer-specific survival (CSS). Multivariable Cox regression models were used to quantify the effect of multiple covariates.
LND was performed in 1,026 patients. In multivariable analysis, the presence of LN metastasis, the number of positive LNs, and LN density were independently associated with cancer-specific mortality (CSM). Clinical node-negative (cN−) disease was documented in 573 patients, 447 of them underwent LND with 43 cN− patients (9.6%) revealing positive LNs at pathology. LN positive cN− patients showed significantly better CSS when compared to LN positive cN+ patients. In multivariable analysis, positive cN status in LN positive patients was a significant predictor of CSM (HR, 2.923; P = 0.015).
The number of positive nodes harvested during LND and LN density was strong prognostic indicators of CSS, while number of removed LNs did not have a significant effect on CSS. The rate of pN1 patients among clinically node-negative patients was relatively high, and LND in these patients suggested a survival benefit. However, only a randomized trial can determine the absolute benefit of LND in this setting.
•RCC patients with tumor thrombus are pT3 by definition; they are at high-risk.•Analysis of the largest multi-institutional RCC tumor thrombus database (IRCC-VTC).•9.6% of clinically node-negative patients were pathologically node-positive.•cN0/pN1 had better CSS when compared to cN1/pN1.</description><identifier>ISSN: 1078-1439</identifier><identifier>EISSN: 1873-2496</identifier><identifier>DOI: 10.1016/j.urolonc.2017.10.008</identifier><identifier>PMID: 29129353</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Carcinoma, Renal Cell - complications ; Carcinoma, Renal Cell - surgery ; Female ; Humans ; Inferior vena cava ; Kidney Neoplasms - complications ; Kidney Neoplasms - surgery ; Lymph Node Excision ; Lymph node metastasis ; Lymph Nodes - pathology ; Lymphadenectomy ; Male ; Middle Aged ; Nephrectomy - methods ; Outcome Assessment, Health Care - methods ; Outcome Assessment, Health Care - statistics & numerical data ; Proportional Hazards Models ; Renal cell carcinoma ; Survival ; Survival Analysis ; Thrombectomy - methods ; Thrombosis - complications ; Thrombosis - surgery ; Vena cava tumor thrombectomy</subject><ispartof>Urologic oncology, 2018-02, Vol.36 (2), p.79.e11-79.e17</ispartof><rights>2018 Elsevier Inc.</rights><rights>Copyright © 2018 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c467t-84a42babbbdcc3946a071ac799168fc05bb4116bb3a6b2ca7199c7c03e2034db3</citedby><cites>FETCH-LOGICAL-c467t-84a42babbbdcc3946a071ac799168fc05bb4116bb3a6b2ca7199c7c03e2034db3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.urolonc.2017.10.008$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,780,784,885,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29129353$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tilki, Derya</creatorcontrib><creatorcontrib>Chandrasekar, Thenappan</creatorcontrib><creatorcontrib>Capitanio, Umberto</creatorcontrib><creatorcontrib>Ciancio, Gaetano</creatorcontrib><creatorcontrib>Daneshmand, Siamak</creatorcontrib><creatorcontrib>Gontero, Paolo</creatorcontrib><creatorcontrib>Gonzalez, Javier</creatorcontrib><creatorcontrib>Haferkamp, Axel</creatorcontrib><creatorcontrib>Hohenfellner, Markus</creatorcontrib><creatorcontrib>Huang, William C.</creatorcontrib><creatorcontrib>Linares Espinós, Estefania</creatorcontrib><creatorcontrib>Lorentz, Adam</creatorcontrib><creatorcontrib>Martinez-Salamanca, Juan I.</creatorcontrib><creatorcontrib>Master, Viraj A.</creatorcontrib><creatorcontrib>McKiernan, James M.</creatorcontrib><creatorcontrib>Montorsi, Francesco</creatorcontrib><creatorcontrib>Novara, Giacomo</creatorcontrib><creatorcontrib>Pahernik, Sascha</creatorcontrib><creatorcontrib>Palou, Juan</creatorcontrib><creatorcontrib>Pruthi, Raj S.</creatorcontrib><creatorcontrib>Rodriguez-Faba, Oscar</creatorcontrib><creatorcontrib>Russo, Paul</creatorcontrib><creatorcontrib>Scherr, Douglas S.</creatorcontrib><creatorcontrib>Shariat, Shahrokh F.</creatorcontrib><creatorcontrib>Spahn, Martin</creatorcontrib><creatorcontrib>Terrone, Carlo</creatorcontrib><creatorcontrib>Vera-Donoso, Cesar</creatorcontrib><creatorcontrib>Zigeuner, Richard</creatorcontrib><creatorcontrib>Libertino, John A.</creatorcontrib><creatorcontrib>Evans, Christopher P.</creatorcontrib><title>Impact of lymph node dissection at the time of radical nephrectomy with tumor thrombectomy on oncological outcomes: Results from the International Renal Cell Carcinoma-Venous Thrombus Consortium (IRCC-VTC)</title><title>Urologic oncology</title><addtitle>Urol Oncol</addtitle><description>To study the effect of lymph node dissection (LND) at the time of nephrectomy and tumor thrombectomy on oncological outcomes in patients with renal cell carcinoma (RCC) and tumor thrombus.
The records of 1,978 patients with RCC and tumor thrombus who underwent radical nephrectomy and tumor thrombectomy from 1985 to 2014 at 24 centers were analyzed. None of the patients had distant metastases. Extent and pathologic results of LND were compared with respect to cancer-specific survival (CSS). Multivariable Cox regression models were used to quantify the effect of multiple covariates.
LND was performed in 1,026 patients. In multivariable analysis, the presence of LN metastasis, the number of positive LNs, and LN density were independently associated with cancer-specific mortality (CSM). Clinical node-negative (cN−) disease was documented in 573 patients, 447 of them underwent LND with 43 cN− patients (9.6%) revealing positive LNs at pathology. LN positive cN− patients showed significantly better CSS when compared to LN positive cN+ patients. In multivariable analysis, positive cN status in LN positive patients was a significant predictor of CSM (HR, 2.923; P = 0.015).
The number of positive nodes harvested during LND and LN density was strong prognostic indicators of CSS, while number of removed LNs did not have a significant effect on CSS. The rate of pN1 patients among clinically node-negative patients was relatively high, and LND in these patients suggested a survival benefit. However, only a randomized trial can determine the absolute benefit of LND in this setting.
•RCC patients with tumor thrombus are pT3 by definition; they are at high-risk.•Analysis of the largest multi-institutional RCC tumor thrombus database (IRCC-VTC).•9.6% of clinically node-negative patients were pathologically node-positive.•cN0/pN1 had better CSS when compared to cN1/pN1.</description><subject>Aged</subject><subject>Carcinoma, Renal Cell - complications</subject><subject>Carcinoma, Renal Cell - surgery</subject><subject>Female</subject><subject>Humans</subject><subject>Inferior vena cava</subject><subject>Kidney Neoplasms - complications</subject><subject>Kidney Neoplasms - surgery</subject><subject>Lymph Node Excision</subject><subject>Lymph node metastasis</subject><subject>Lymph Nodes - pathology</subject><subject>Lymphadenectomy</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Nephrectomy - methods</subject><subject>Outcome Assessment, Health Care - methods</subject><subject>Outcome Assessment, Health Care - statistics & numerical data</subject><subject>Proportional Hazards Models</subject><subject>Renal cell carcinoma</subject><subject>Survival</subject><subject>Survival Analysis</subject><subject>Thrombectomy - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Urologic oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tilki, Derya</au><au>Chandrasekar, Thenappan</au><au>Capitanio, Umberto</au><au>Ciancio, Gaetano</au><au>Daneshmand, Siamak</au><au>Gontero, Paolo</au><au>Gonzalez, Javier</au><au>Haferkamp, Axel</au><au>Hohenfellner, Markus</au><au>Huang, William C.</au><au>Linares Espinós, Estefania</au><au>Lorentz, Adam</au><au>Martinez-Salamanca, Juan I.</au><au>Master, Viraj A.</au><au>McKiernan, James M.</au><au>Montorsi, Francesco</au><au>Novara, Giacomo</au><au>Pahernik, Sascha</au><au>Palou, Juan</au><au>Pruthi, Raj S.</au><au>Rodriguez-Faba, Oscar</au><au>Russo, Paul</au><au>Scherr, Douglas S.</au><au>Shariat, Shahrokh F.</au><au>Spahn, Martin</au><au>Terrone, Carlo</au><au>Vera-Donoso, Cesar</au><au>Zigeuner, Richard</au><au>Libertino, John A.</au><au>Evans, Christopher P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of lymph node dissection at the time of radical nephrectomy with tumor thrombectomy on oncological outcomes: Results from the International Renal Cell Carcinoma-Venous Thrombus Consortium (IRCC-VTC)</atitle><jtitle>Urologic oncology</jtitle><addtitle>Urol Oncol</addtitle><date>2018-02-01</date><risdate>2018</risdate><volume>36</volume><issue>2</issue><spage>79.e11</spage><epage>79.e17</epage><pages>79.e11-79.e17</pages><issn>1078-1439</issn><eissn>1873-2496</eissn><abstract>To study the effect of lymph node dissection (LND) at the time of nephrectomy and tumor thrombectomy on oncological outcomes in patients with renal cell carcinoma (RCC) and tumor thrombus.
The records of 1,978 patients with RCC and tumor thrombus who underwent radical nephrectomy and tumor thrombectomy from 1985 to 2014 at 24 centers were analyzed. None of the patients had distant metastases. Extent and pathologic results of LND were compared with respect to cancer-specific survival (CSS). Multivariable Cox regression models were used to quantify the effect of multiple covariates.
LND was performed in 1,026 patients. In multivariable analysis, the presence of LN metastasis, the number of positive LNs, and LN density were independently associated with cancer-specific mortality (CSM). Clinical node-negative (cN−) disease was documented in 573 patients, 447 of them underwent LND with 43 cN− patients (9.6%) revealing positive LNs at pathology. LN positive cN− patients showed significantly better CSS when compared to LN positive cN+ patients. In multivariable analysis, positive cN status in LN positive patients was a significant predictor of CSM (HR, 2.923; P = 0.015).
The number of positive nodes harvested during LND and LN density was strong prognostic indicators of CSS, while number of removed LNs did not have a significant effect on CSS. The rate of pN1 patients among clinically node-negative patients was relatively high, and LND in these patients suggested a survival benefit. However, only a randomized trial can determine the absolute benefit of LND in this setting.
•RCC patients with tumor thrombus are pT3 by definition; they are at high-risk.•Analysis of the largest multi-institutional RCC tumor thrombus database (IRCC-VTC).•9.6% of clinically node-negative patients were pathologically node-positive.•cN0/pN1 had better CSS when compared to cN1/pN1.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>29129353</pmid><doi>10.1016/j.urolonc.2017.10.008</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1078-1439 |
| ispartof | Urologic oncology, 2018-02, Vol.36 (2), p.79.e11-79.e17 |
| issn | 1078-1439 1873-2496 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8404533 |
| source | MEDLINE; ScienceDirect Journals (5 years ago - present) |
| subjects | Aged Carcinoma, Renal Cell - complications Carcinoma, Renal Cell - surgery Female Humans Inferior vena cava Kidney Neoplasms - complications Kidney Neoplasms - surgery Lymph Node Excision Lymph node metastasis Lymph Nodes - pathology Lymphadenectomy Male Middle Aged Nephrectomy - methods Outcome Assessment, Health Care - methods Outcome Assessment, Health Care - statistics & numerical data Proportional Hazards Models Renal cell carcinoma Survival Survival Analysis Thrombectomy - methods Thrombosis - complications Thrombosis - surgery Vena cava tumor thrombectomy |
| title | Impact of lymph node dissection at the time of radical nephrectomy with tumor thrombectomy on oncological outcomes: Results from the International Renal Cell Carcinoma-Venous Thrombus Consortium (IRCC-VTC) |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-06T02%3A15%3A51IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Impact%20of%20lymph%20node%20dissection%20at%20the%20time%20of%20radical%20nephrectomy%20with%20tumor%20thrombectomy%20on%20oncological%20outcomes:%20Results%20from%20the%20International%20Renal%20Cell%20Carcinoma-Venous%20Thrombus%20Consortium%20(IRCC-VTC)&rft.jtitle=Urologic%20oncology&rft.au=Tilki,%20Derya&rft.date=2018-02-01&rft.volume=36&rft.issue=2&rft.spage=79.e11&rft.epage=79.e17&rft.pages=79.e11-79.e17&rft.issn=1078-1439&rft.eissn=1873-2496&rft_id=info:doi/10.1016/j.urolonc.2017.10.008&rft_dat=%3Cproquest_pubme%3E1963482645%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1963482645&rft_id=info:pmid/29129353&rft_els_id=S1078143917305434&rfr_iscdi=true |