J Cancer 2019; 10(19):4639-4646. doi:10.7150/jca.33923 This issue

Research Paper

Adverse Effect of Lymph Node Dissection in Metastatic Renal Cell Cancer Patients Treated with Cytoreductive Nephrectomy: A Contemporary Analysis of Survival

Dalong Cao1,2✉*, Yongqiang Huang1,2*, Chuankai Zhang3*, Junlong Wu1,2, Leijun Yu1,2, Hailiang Zhang1,2, Guohai Shi1,2, Dingwei Ye1,2✉

1. Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
2. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
3. Department of Burn and Plastic Surgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China.
*These authors contributed equally.

This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/). See http://ivyspring.com/terms for full terms and conditions.
Cao D, Huang Y, Zhang C, Wu J, Yu L, Zhang H, Shi G, Ye D. Adverse Effect of Lymph Node Dissection in Metastatic Renal Cell Cancer Patients Treated with Cytoreductive Nephrectomy: A Contemporary Analysis of Survival. J Cancer 2019; 10(19):4639-4646. doi:10.7150/jca.33923. Available from https://www.jcancer.org/v10p4639.htm

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Background and objectives: In patients with metastatic renal cell cancer (mRCC), cytoreductive nephrectomy (CN) may occasionally be performed. However, the role of lymph node dissection (LND) for such cases is unknown in era of target therapy. To test the effect of LND at CN on cancer-specific survival (CSS), overall survival (OS) in era of target therapy compared with no LND in patients with mRCC.

Methods: A total of 4690 mRCC patients treated with CN were identified within the Surveillance, Epidemiology, and End Result (SEER) database (2006-2015). Survival differences were assessed by Kaplan-Meier estimate and compared using log-rank test. Multivariable Cox regression analysis (MCR) was used to evaluate the effect of LND on CSS and OS.

Results: Within the SEER database, 1902 (40.6%) of 4690 mRCC patients underwent LND at CN. MCR analysis showed that LND at CN exhibited lower CSS (hazard ratio [HR] 1.18, 95% confidence interval (CI) 1.09-1.27; p < 0.01) and OS (HR 1.13, 95% CI 1.05-1.21; p < 0.01) compared with non-LND in mRCC patients. The adverse effect of LND on CSS and OS were also detected in metastatic patients with clear cell RCC (ccRCC) and non-ccRCC (all p<0.0001). Additionally, the association of number of resected node with CSS (HR 0.98, 95% CI 0.88-1.10; p = 0.68) and OS (HR 1.00, 95% CI 0.89-1.11; p = 0.93) were not observed in MCR analysis.

Conclusion: We are the first to demonstrate that LND at CN is associated with poor CSS and OS in metastatic patients with ccRCC and non-ccRCC. Considering that the current study is retrospective, these findings' impact on clinical practice needs to be further verified in future validation studies.

Keywords: Metastatic renal cell cancer, Cytoreductive nephrectomy, Surveillance, Epidemiology and End Result program, Lymph node dissection, Cancer-specific survival, Overall survival