1838 WHEN TO PERFORM LYMPH NODE DISSECTION IN RENAL CELL CARCINOMA PATIENTS: A NOVEL APPROACH TO PREOPERATIVELY ASSESS THE RISK OF LYMPH NODE INVASION AT SURGERY AND NODAL PROGRESSION DURING FOLLOW UP

Abstract

You have accessJournal of UrologyKidney Cancer: Advanced (I)1 Apr 20131838 WHEN TO PERFORM LYMPH NODE DISSECTION IN RENAL CELL CARCINOMA PATIENTS: A NOVEL APPROACH TO PREOPERATIVELY ASSESS THE RISK OF LYMPH NODE INVASION AT SURGERY AND NODAL PROGRESSION DURING FOLLOW UP Umberto Capitanio, Firas Abdollah, Rayan Matloob, Nazareno Suardi, Andrea Gallina, Paolo Capogrosso, Marco Moschini, Paolo Dell'Oglio, Cristina Carenzi, Alberto Briganti, Francesco Montorsi, and Roberto Bertini Umberto CapitanioUmberto Capitanio Milan, Italy More articles by this author , Firas AbdollahFiras Abdollah Milan, Italy More articles by this author , Rayan MatloobRayan Matloob Milan, Italy More articles by this author , Nazareno SuardiNazareno Suardi Milan, Italy More articles by this author , Andrea GallinaAndrea Gallina Milan, Italy More articles by this author , Paolo CapogrossoPaolo Capogrosso Milan, Italy More articles by this author , Marco MoschiniMarco Moschini Milan, Italy More articles by this author , Paolo Dell'OglioPaolo Dell'Oglio Milan, Italy More articles by this author , Cristina CarenziCristina Carenzi Milan, Italy More articles by this author , Alberto BrigantiAlberto Briganti Milan, Italy More articles by this author , Francesco MontorsiFrancesco Montorsi Milan, Italy More articles by this author , and Roberto BertiniRoberto Bertini Milan, Italy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2221AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Whether to perform lymph node dissection (LND) in renal cell carcinoma (RCC) is still debated. We aimed to preoperatively identify patients who might benefit from a LND. METHODS In 1983 RCC patients treated with partial or radical nephrectomy, we considered as a mutual endpoint the presence of lymph node invasion (LNI) at final pathology and lymph node (LN) progression during the follow-up period. Nodal progression was defined as the onset of a new clinically detected lymphadenopathy (>10 mm) in the retroperitoneal lymphatic area. Moreover, all the variables available before surgery were tested as potential predictors of LNI and/or LN progression. Regression analyses were used to assess the effect of each clinical predictor (age, body mass index, tumor side, symptoms, performance status, clinical tumor size, clinical TNM stage, albumin, calcium, creatinine, haemoglobin, and platelets levels) on the outcome of interest. The most parsimonious multivariable predictive model was developed. Discrimination, calibration and net benefit were calculated. RESULTS The prevalence of nodal invasion was 6.1% (n=120/1983). During the follow-up period, 82 patients (4.1%) experienced nodal progression. Of those, 17 (20.7%), 38 (46.3%) and 27 (32.9%) were pNx, pN0 and pN1 cases at surgery, respectively. Therefore, the rate of patients who experienced lymph node progression resulted 1.5 vs. 5.0 vs. 22.5% in pNx vs. pN0 vs. pN1, respectively. At multivariable analyses, the most informative independent predictors resulted T stage [cT3-4 vs. cT1-2, odds ratio (OR) 1.52, p=0.05], clinical nodal status [cN1 vs. cN0, OR 7.09, p<0.001], metastases at diagnosis (OR 3.04, p<0.001) and clinical tumor size (OR 1.14, p<0.001). The accuracy of the multivariable model resulted 86.9% with excellent calibration and net benefit. The use of a nomogram cutoff of 3% would allow the avoid of roughly 50% of the procedures with a very low false negative rate (7.4%). CONCLUSIONS By relying on an unique approach combining the risk of harbouring LNI and/or LN progression during follow-up period, we provided the first clinical pre-surgery model predicting the need for LND. The model showed excellent accuracy and calibration, with a significant benefit in decision curve analyses. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e755 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Umberto Capitanio Milan, Italy More articles by this author Firas Abdollah Milan, Italy More articles by this author Rayan Matloob Milan, Italy More articles by this author Nazareno Suardi Milan, Italy More articles by this author Andrea Gallina Milan, Italy More articles by this author Paolo Capogrosso Milan, Italy More articles by this author Marco Moschini Milan, Italy More articles by this author Paolo Dell'Oglio Milan, Italy More articles by this author Cristina Carenzi Milan, Italy More articles by this author Alberto Briganti Milan, Italy More articles by this author Francesco Montorsi Milan, Italy More articles by this author Roberto Bertini Milan, Italy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...