Prognostic Value of Positive Lymph Nodes in Patients with Renal Cell Carcinoma and Tumor Thrombus Undergoing Nephrectomy and Thrombectomy

2021 ◽  
pp. 1-9
Author(s):  
Ruotao Xiao ◽  
Chuxiao Xu ◽  
Liyuan Ge ◽  
Wei He ◽  
Bin Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Cell Carcinoma ◽  
Lymph Nodes ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Prognostic Value ◽  
Tumor Thrombus ◽  
Survival Outcomes ◽  
Positive Lymph Nodes ◽  
Sarcomatoid Differentiation

<b><i>Introductions:</i></b> The objective of this study was to determine the prognostic value of positive lymph nodes (LNs) in patients with renal cell carcinoma (RCC) and tumor thrombus (TT) and to explore risk factors predicting LNs metastasis. <b><i>Methods:</i></b> We retrospectively analyzed 216 patients with RCC and TT treated at a single institution from January 2015 to December 2019. Overall survival (OS) and progression-free survival (PFS) was estimated using the Kaplan-Meier curves divided by pathological LN status. Associations between clinicopathological features and survival outcomes were evaluated using Cox regression models. Logistic regression model was performed to determine risk factors associated with LN metastasis. <b><i>Results:</i></b> We identified 216 patients with RCC and TT including 85 (39.4%) who did and 131 (60.6%) who did not undergo lymph node dissection. Pathologically positive LNs were found in 18 (8.3%) cases. pN1 had significant worse OS (median: 21 vs. 41 and 56 months, <i>p</i> &#x3c; 0.001) and PFS (median:14 vs. 29 and 33 months, <i>p</i> &#x3c; 0.001) than pN0 and pNx respectively. However, survival outcomes of OS and PFS were similar between pNx-0/M1 and pN1/M0 group and between 1- and ≥2-node-positive group. Non-CCRCC (<i>p</i> = 0.001), sarcomatoid differentiation (<i>p</i> &#x3c; 0.001), and pathologically positive LNs (<i>p</i> = 0.025) were independent prognostic predictors predicting worse OS while distance metastasis (<i>p</i> = 0.009), non-CCRCC (<i>p</i> = 0.023), necrosis (<i>p</i> = 0.014), sarcomatoid differentiation (<i>p</i> = 0.003), and pathologically positive LNs (<i>p</i> = 0.007) were independent prognostic indicators predicting worse PFS. Clinically positive LNs (<i>p</i> = 0.014) and sarcomatoid differentiation (<i>p</i> = 0.009) were predictors of positive LNs. <b><i>Conclusions:</i></b> LNs metastasis independently associated with worse survival outcomes in RCC and TT populations, with similar survival outcomes compared to distance metastasis. Therefore, more accurate risk stratification is warranted for guiding postoperative surveillance and adjuvant therapy.

Renal Lymph Nodes for Tumor Staging: Appraisal of 871 Nephrectomies With Examination of Hilar Fat

2013 ◽  
Vol 137 (11) ◽  
pp. 1584-1590 ◽  
Author(s):  
Vikas Mehta ◽  
Kumaran Mudaliar ◽  
Ritu Ghai ◽  
Marcus L. Quek ◽  
John Milner ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Cell Carcinoma ◽  
Microscopic Examination ◽  
Renal Cell ◽  
Fatty Tissue ◽  
Renal Malignancies ◽  
Positive Lymph Nodes

Context.—Despite decades of research, the role of lymphadenectomy in the management of renal cell carcinoma (RCC) is still not clearly defined. Before the implementation of targeted therapies, lymph node metastases were considered to be a portent of markedly decreased survival, regardless of the tumor stage. However, the role of lymphadenectomy and the relative benefit of retroperitoneal lymph node dissection in the context of modern adjunctive therapies have not been conclusively addressed in the clinical literature. The current pathologic literature does not offer clear recommendations with regard to the minimum number of lymph nodes that should be examined in order to accurately stage the pN in renal cell carcinoma. Although gross examination of the hilar fat to assess the nodal status is performed routinely, it has not yet been determined whether this approach is adequate. Objective.—To evaluate the status of lymph nodes and their rate of identification in the pathologic examination of nephrectomy specimens in adult renal malignancies. Design.—We reviewed the operative and pathology reports of 871 patients with renal malignancies treated by nephrectomy. All tumors were classified according to the seventh edition of the Tumor-Nodes-Metastasis classification. Patients were divided into 3 groups: Nx, no lymph nodes recovered; N0, negative; and N1, with positive lymph nodes. Grossly visible lymph nodes were submitted separately; as per grossing protocol, hilar fatty tissue was submitted for microscopic examination. We evaluated the factors that affected the number of lymph nodes identified and the variables that allowed the prediction of nodal involvement. Results.—Lymph nodes were recovered in 333 of 871 patients (38%): hilar in 125 patients, nonhilar in 137 patients, and hilar and nonhilar in 71 patients. Patients with positive lymph nodes (n = 87) were younger, had larger primary tumors, and had lymph nodes of average size, as well as a higher pT stage, nuclear grade, and rate of metastases. Metastases were seen only in grossly identified lymph nodes (65% hilar, 16% nonhilar); all microscopic nodes were negative. Even with the microscopic examination of fat, hilar lymph nodes were recovered in only 22.5% of patients. A nonhilar route of node metastasis was suspected in 40 patients. Conclusions.—Only grossly identifiable lymph nodes, both hilar and nonhilar, were positive for metastases. Although microscopic examination of the hilar fat increased the number of lymph nodes recovered, the identification rate of these nodes was low (22.5%), and such microscopic nodes were invariably negative. Hence, microscopic examination of the hilar fat may be unnecessary.

scholarly journals Influence of Tumor Thrombus on Occurrence of Distant Venous Thromboembolism and Survival in Patients With Renal Cell Carcinoma After Surgery

2019 ◽  
Vol 25 ◽  
pp. 107602961882328 ◽  
Author(s):  
Hyunkyung Park ◽  
Chang Wook Jeong ◽  
Hyeongdong Yuk ◽  
Ja Hyeon Ku ◽  
Hyeon Hoe Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Cell Carcinoma ◽  
Venous Thromboembolism ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Tumor Thrombus ◽  
Multivariable Analysis ◽  
Significant Risk ◽  
Increased Risk ◽  
The Impact

Tumor thrombus is a unique characteristic of renal cell carcinoma (RCC). However, only a few studies have reported its clinical influence on the occurrence of venous thromboembolism (VTE). This study aimed to clarify the influence of tumor thrombus and other risk factors for VTE and to elucidate the impact of tumor thrombus on survival outcomes. We retrospectively reviewed data from patients with RCC who underwent radical or partial nephrectomy from September 1999 to August 2015 at Seoul National University Hospital. A total of 2762 patients were enrolled. The 1- and 5-year cumulative incidences of VTE were 0.5% ± 0.1% and 1.5% ± 0.3%, respectively. During a median follow-up of 39.0 months (95% confidence interval [CI], 37.1-41.0 months), deep vein thrombosis occurred in 13 patients and pulmonary embolism in 15 patients. Patients with tumor thrombus (diagnosed by surgical pathology findings) had a significantly higher incidence of VTE than those without thrombus (odds radio 8.160, 95% CI, 1.480-45.004). Older age (≥60 years) and higher preoperative C-reactive protein (>0.5 mg/dL) were also significant risk factors for VTE. Additionally, tumor thrombus was independently associated with worse progression-free survival (PFS) but not with overall survival (OS) in multivariable analysis (hazard ratio [HR] 1.916, 95% CI, 1.295-2.834 for PFS; HR 1.164, 95% CI, 0.755-1.793 for OS). In conclusion, the incidence of VTE was relatively low in patients who underwent surgery for RCC. Nevertheless, patients with tumor thrombus had an increased risk of VTE and should be closely monitored for VTE.

73: Preoperative and Intraoperative Features Associated with Positive Lymph Nodes During Nephrectomy for Renal Cell Carcinoma

2006 ◽  
Vol 175 (4S) ◽  
pp. 24-25
Author(s):  
R. Houston Thompson ◽  
Christine M. Lohse ◽  
Igor Frank ◽  
Horst Zincke ◽  
Michael L. Blute ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Lymph Nodes ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Positive Lymph Nodes

scholarly journals Prognostic Outcomes and Risk Factors for Patients with Renal Cell Carcinoma and Venous Tumor Thrombus after Radical Nephrectomy and Thrombectomy: The Prognostic Significance of Venous Tumor Thrombus Level

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Qi Tang ◽  
Yi Song ◽  
Xuesong Li ◽  
Maxwell Meng ◽  
Qian Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Cell Carcinoma ◽  
Survival Rate ◽  
Cell Carcinoma ◽  
Hepatic Vein ◽  
Renal Cell ◽  
Radical Nephrectomy ◽  
Tumor Thrombus ◽  
Cancer Specific Survival ◽  
Venous Tumor Thrombus

Introduction. To evaluate the prognostic outcomes and risk factors for renal cell carcinoma (RCC) patients with venous tumor thrombus in China.Materials and Methods. We reviewed the clinical information of 169 patients who underwent radical nephrectomy and thrombectomy. Overall and cancer-specific survival rates were analyzed. Univariate and multivariate analyses were used to investigate the potential prognostic factors.Results. The median survival time was 63 months. The five-year overall survival and cancer-specific survival rate were 53.6% and 54.4% for all patients. For all patients, significant survival difference was only observed between early (below hepatic vein) and advanced (above hepatic vein) tumor thrombus. However, significant differences existed between both RV/IVC and early/advanced tumor thrombus groups in N0M0 patients. Multivariate analysis demonstrated that higher tumor thrombus level (p=0.016,RR=1.58), N (p=0.013,RR=2.60), and M (p<0.001,RR=4.14) stages and adrenal gland invasion (p=0.001,RR=4.91) were the most significant negative prognostic predictors.Conclusions. In this study, we reported most cases of RCC patients with venous extension in China. We proved that patients with RCC and venous tumor thrombus may have relative promising long-term survival rate, especially those with early tumor thrombus.

PREOPERATIVE NOMOGRAM TO PREDICT POSITIVE LYMPH NODES DURING NEPHRECTOMY FOR RENAL CELL CARCINOMA

2008 ◽  
Vol 179 (4S) ◽  
pp. 212-212 ◽  
Author(s):  
R Houston Thompson ◽  
Ganesh V Raj ◽  
Bradley C Leibovich ◽  
Paul Russo ◽  
Michael L Blute ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Lymph Nodes ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Positive Lymph Nodes
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