MP03-13 Clinical Outcomes in Patients with Metastatic Papillary Renal Cell Carcinoma: A Japanese Multi-Institutional Study (original) (raw)

2016, The Journal of Urology

INTRODUCTION AND OBJECTIVES: The oncologic benefit of retroperitoneal lymph node dissection (LND) for patients undergoing cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma (RCC) has not been established. We investigated the association of LND with oncologic outcomes among patients undergoing CN. METHODS: We identified 305 patients treated with CN for M1 RCC between 1990 and 2010, of whom 188 (62%) underwent LND. A propensity score (PS) for receipt of LND was estimated using clinicopathologic features. The associations of LND with cancer-specific (CSM) and all-cause mortality (ACM) were evaluated using Cox regression models and several PS techniques including stratification by PS quintile, adjustment for PS quintile, and inverse probability weighting (IPW). Internally predicted probabilities for pN1 disease were estimated using logistic regression. RESULTS: Overall, 74 (24%) patients were pN1. After PS adjustment, there were no significant differences in clinicopathologic features according to receipt of LND. Median follow-up among survivors was 8.5 years, during which time 284 patients died, including 274 from RCC. In the overall cohort, LND was not significantly associated with CSM or ACM using any of the PS techniques (Table). We further examined whether LND was associated with survival outcomes among patients at increased risk of pN1 disease. Among patients with radiographically enlarged nodes (cN1), LND was not significantly associated with CSM or ACM. Moreover, across increasing threshold probabilities for pN1 disease of 20%, 40%, 60%, or 80%, LND was not associated with reduced CSM or ACM. CONCLUSIONS: Among patients undergoing CN for metastatic RCC, LND was not associated with improved oncologic outcomes in the overall cohort, for patients with radiographic cN1 disease, or across increasing probability thresholds for pN1 disease. These findings suggest that LND at the time of CN does not confer an oncologic benefit by cytoreduction of nodal metastases.