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. 2018 Mar 28:5:26.
doi: 10.3389/fsurg.2018.00026. eCollection 2018.

The Effect of Anatomical Location of Lymph Node Metastases on Cancer Specific Survival in Patients with Clear Cell Renal Cell Carcinoma

Alessandro Nini  1   2 , Alessandro Larcher  1   2 , Francesco Cianflone  1   2 , Francesco Trevisani  1   2 , Carlo Terrone  3 , Alessandro Volpe  3 , Federica Regis  3 , Alberto Briganti  1   2 , Andrea Salonia  1   2 , Francesco Montorsi  1   2 , Roberto Bertini  1   2 , Umberto Capitanio  1   2
Affiliations

The Effect of Anatomical Location of Lymph Node Metastases on Cancer Specific Survival in Patients with Clear Cell Renal Cell Carcinoma

Alessandro Nini et al. Front Surg. .

Abstract

Background: Positive nodal status (pN1) is an independent predictor of survival in renal cell carcinoma (RCC) patients. However, no study to date has tested whether the location of lymph node (LN) metastases does affect oncologic outcomes in a population submitted to radical nephrectomy (RN) and extended lymph node dissection (eLND).

Objective: To describe nodal disease dissemination in clear cell RCC (ccRCC) patients and to assess the effect of the anatomical sites and the number of nodal areas affected on cancer specific mortality (CSM).

Design setting and partecipants: The study included 415 patients who underwent RN and eLND, defined as the removal of hilar, side-specific (pre/paraaortic or pre/paracaval) and interaortocaval LNs for ccRCC, at two institutions.

Outcome measurement and statistical analysis: Descriptive statistics were used to depict nodal dissemination in pN1 patients, stratified according to nodal site and number of involved areas. Multivariable Cox regression analyses and Kaplan-Meier curves were used to explore the relationship between pN1 disease features and survival outcomes.

Results and limitations: Median number of removed LN was 14 (IQR 9-19); 23% of patients were pN1. Among patients with one involved nodal site, 54 and 26% of patients were positive only in side-specific and interaortocaval station, respectively. The most frequent nodal site was the interaortocaval and side-specific one, for right and left ccRCC, respectively. Interaortocaval nodal positivity (HR 2.3, CI 95%: 1.3-3.9, p < 0.01) represented an independent predictor of CSM.

Conclusions: When ccRCC patient harbour nodal disease, its spreading can occur at any nodal station without involving the others. The presence of interoartocaval positive nodes does affect oncologic outcomes.

Patient summary: Lymph node invasion in patients with clear cell renal cell carcinoma is not following a fixed anatomical pattern. An extended lymph node dissection, during treatment for primary kidney tumour, would aid patient risk stratification and multimodality upfront treatment.

Keywords: kidney cancer; lymph node invasion; metastases; renal cancer; survival.

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Figures

Figure 1
Figure 1
Sketch of left and right nodal templates (left template in red and right template in blue), adapted from (2).
Figure 2
Figure 2
Kaplan-Meier depicting CSM-free survival rate on the overall population after stratification for the pN status (p-value < 0.01). Blue line: pN0 patients; Green line: pN1 patients.
Figure 3
Figure 3
Nodal metastatic dissemination in the overall population and after stratification for the kidney site according to nodal areas and number of areas involved.
Figure 4
Figure 4
Kaplan-Meier depicting CSM-free survival rate only in pN+ patients after stratification for the number of locations of nodal metastases (p = 0.5). Blue line: 1 positive nodal site; Green line: 2 positive nodal sites; Grey line: 3 positive nodal sites.
See this image and copyright information in PMC

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