PMID- 28940649
OWN - NLM
STAT- MEDLINE
DCOM- 20180313
LR  - 20220408
IS  - 1464-410X (Electronic)
IS  - 1464-4096 (Linking)
VI  - 121
IP  - 3
DP  - 2018 Mar
TI  - The impact of lymph node dissection and positive lymph nodes on cancer-specific 
      mortality in contemporary pT(2-3) non-metastatic renal cell carcinoma treated 
      with radical nephrectomy.
PG  - 383-392
LID - 10.1111/bju.14024 [doi]
AB  - OBJECTIVE: To assess the effect of lymph node dissection (LND), number of removed 
      nodes (NRN), and number of positive nodes (NPN), on cancer-specific mortality 
      (CSM) in contemporary vs historical patients with pT(2-3) N(any) M(0) renal cell 
      carcinoma (RCC) treated with radical nephrectomy (RN). PATIENTS AND METHODS: 
      Within the Surveillance, Epidemiology, and End Results database (2001-2013), we 
      identified patients with non-metastatic pT(2-3) N(any) RCC who underwent RN with 
      or without LND. Kaplan-Meier analyses and multivariable Cox regression models 
      with propensity score weighting for inverse probability of treatment were used. 
      RESULTS: Of 25 357 patients, 24.8% underwent LND (2001-2007: 3 167 patients vs 
      2008-2013: 3 133 patients). The median NRN was 3 (interquartile range [IQR]: 
      1-7). Positive nodes were identified in 17.1%: 9.3% of pT(2) and 21.6% of pT(3) 
      patients, who underwent LND. The median NPN was 2 (IQR: 1-3). In multivariable 
      models, LND did not decrease CSM (hazard ratio [HR] 1.29; P < 0.001). LND extent, 
      defined as NRN, did not decrease CSM (HR 0.94; P = 0.3). Finally, multivariable 
      models testing the effect of NPN showed increased CSM in pT(3) but not in pT(2) 
      patients (HR 1.29 and 1.58, P = 0.02 and P = 0.1, respectively). NRN exerted a 
      protective effect on CSM in patients with positive nodes (HR 0.98; P = 0.007). 
      CONCLUSION: In contemporary and historical patients LND or its extent do not 
      protect from CSM. However, the NPN increases the rate of CSM in pT(3) patients. 
      Consequently, LND and its extent appear to have little if any therapeutic value 
      in pT(2-3) N(any) M(0) patients, besides its prognostic impact. High-risk 
      non-metastatic patients may represent a target population for a 
      multi-institutional prospective trial.
CI  - (c) 2017 The Authors BJU International (c) 2017 BJU International Published by John 
      Wiley & Sons Ltd.
FAU - Marchioni, Michele
AU  - Marchioni M
AUID- ORCID: 0000-0002-1702-4127
AD  - Department of Urology, SS Annunziata Hospital, 'G. D'Annunzio' University of 
      Chieti, Chieti, Italy.
AD  - Cancer Prognostics and Health Outcomes Unit, University of Montreal Health 
      Center, Montreal, QC, Canada.
FAU - Bandini, Marco
AU  - Bandini M
AUID- ORCID: 0000-0002-1462-1698
AD  - Cancer Prognostics and Health Outcomes Unit, University of Montreal Health 
      Center, Montreal, QC, Canada.
AD  - Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele and 
      Vita-Salute San Raffaele University, Milan, Italy.
FAU - Pompe, Raisa S
AU  - Pompe RS
AD  - Cancer Prognostics and Health Outcomes Unit, University of Montreal Health 
      Center, Montreal, QC, Canada.
AD  - Martini Klinik Prostate Cancer Center, University Medical Center 
      Hamburg-Eppendorf, Hamburg, Germany.
FAU - Martel, Tristan
AU  - Martel T
AD  - Cancer Prognostics and Health Outcomes Unit, University of Montreal Health 
      Center, Montreal, QC, Canada.
AD  - Department of Urology, University of Montreal Health Center, Montreal, QC, 
      Canada.
FAU - Tian, Zhe
AU  - Tian Z
AD  - Cancer Prognostics and Health Outcomes Unit, University of Montreal Health 
      Center, Montreal, QC, Canada.
FAU - Shariat, Shahrokh F
AU  - Shariat SF
AD  - Department of Urology, Medical University of Vienna, Vienna, Austria.
FAU - Kapoor, Anil
AU  - Kapoor A
AD  - Division of Urology, McMaster University, Hamilton, ON, Canada.
FAU - Cindolo, Luca
AU  - Cindolo L
AD  - Department of Urology, ASL Abruzzo 2, Chieti, Italy.
FAU - Briganti, Alberto
AU  - Briganti A
AD  - Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele and 
      Vita-Salute San Raffaele University, Milan, Italy.
FAU - Schips, Luigi
AU  - Schips L
AD  - Department of Urology, ASL Abruzzo 2, Chieti, Italy.
FAU - Capitanio, Umberto
AU  - Capitanio U
AUID- ORCID: 0000-0001-9225-1795
AD  - Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele and 
      Vita-Salute San Raffaele University, Milan, Italy.
FAU - Karakiewicz, Pierre I
AU  - Karakiewicz PI
AD  - Cancer Prognostics and Health Outcomes Unit, University of Montreal Health 
      Center, Montreal, QC, Canada.
AD  - Department of Urology, University of Montreal Health Center, Montreal, QC, 
      Canada.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20171012
PL  - England
TA  - BJU Int
JT  - BJU international
JID - 100886721
SB  - IM
MH  - Aged
MH  - Carcinoma, Renal Cell/*mortality/secondary/*surgery
MH  - Female
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Kidney Neoplasms/*mortality/pathology/*surgery
MH  - *Lymph Node Excision
MH  - Lymph Nodes/pathology/*surgery
MH  - Lymphatic Metastasis
MH  - Male
MH  - Middle Aged
MH  - Neoplasm Staging
MH  - Nephrectomy
MH  - Proportional Hazards Models
MH  - SEER Program
MH  - Survival Rate
MH  - Time Factors
MH  - United States/epidemiology
OTO - NOTNLM
OT  - SEER database
OT  - lymph node dissection
OT  - radical nephrectomy
OT  - renal cell carcinoma
EDAT- 2017/09/25 06:00
MHDA- 2018/03/14 06:00
CRDT- 2017/09/24 06:00
PHST- 2017/09/25 06:00 [pubmed]
PHST- 2018/03/14 06:00 [medline]
PHST- 2017/09/24 06:00 [entrez]
AID - 10.1111/bju.14024 [doi]
PST - ppublish
SO  - BJU Int. 2018 Mar;121(3):383-392. doi: 10.1111/bju.14024. Epub 2017 Oct 12.