MP40-04 HAS THE NEW EDITION OF THE TNM IMPROVED THE LYMPH NODE STAGING FOR RENAL CELL CARCINOMA ?

Abstract

You have accessJournal of UrologyKidney Cancer; Evaluation/Staging IV1 Apr 2014MP40-04 HAS THE NEW EDITION OF THE TNM IMPROVED THE LYMPH NODE STAGING FOR RENAL CELL CARCINOMA ? Carlo Terrone, Umberto Capitanio, Alessandro Volpe, Ettore Di Trapani, Rayan Matloob, Paolo De Angelis, Andrea Russo, Monica Zacchero, Marta Fusano, Alberto Briganti, Roberto Tarabuzzi, Roberto Bertini, and Francesco Montorsi Carlo TerroneCarlo Terrone More articles by this author , Umberto CapitanioUmberto Capitanio More articles by this author , Alessandro VolpeAlessandro Volpe More articles by this author , Ettore Di TrapaniEttore Di Trapani More articles by this author , Rayan MatloobRayan Matloob More articles by this author , Paolo De AngelisPaolo De Angelis More articles by this author , Andrea RussoAndrea Russo More articles by this author , Monica ZaccheroMonica Zacchero More articles by this author , Marta FusanoMarta Fusano More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Roberto TarabuzziRoberto Tarabuzzi More articles by this author , Roberto BertiniRoberto Bertini More articles by this author , and Francesco MontorsiFrancesco Montorsi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1339AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives The most commonly used staging system of Renal Cell Carcinoma (RCC) is the TNM system. In the last editions of this classification, lymph node (LN) involvement was defined independently of the number of positive LNs. Previously, there were pN1 and pN2 subcategories, identifying cases with one or more than one positive LNs, respectively. The aim of this study was to evaluate the prognostic value of LN involvement taking into account the number of LN removed and the number of positive LNs. Methods All the pathological reports of the radical nephrectomies for RCC performed in three Tertiary Care Centers from November 1983 to December 2012, were reviewed. For each patient complete pathological data, extension of lymphadenectomy, number of LNs removed, number of positive LNs and ratio between number of positive LNs and total number of LNs (LN density) were recorded. The pathological stage was determined according to the TNM seventh edition. Kaplan-Meyer method and log-rank test were used to calculate the cause-specific survival rate and to compare the survival curves, respectively. Cox proportional hazards regression model was used to determine the variables that were independently correlated with cancer death. Results There were 2884 patients. Lymphadenectomy was performed in 1550 cases. The median age of these patients was 60.0 years (range 21-88). Median follow period was 57.6 months. The rate of positive LNs was 13.3%. The average number of LNs removed was 7 (range 1-58). The median number of LNs involved was 3 (range 1-23). Limited lymphadenectomy was performed in 552 patients. The 5-year cause-specific survival rate of pN+ cases was 19.5%. There was no difference in 5-year cause-specific survival between patients with 1 positive LN and patients with more than 1 positive LN (23% vs 18%; p=0.1). A significant difference was only found in patients with distant metastases at diagnosis (16.5% vs 0%). Similar results were obtained limiting the analysis to the patients submitted to complete lymphadenectomy. A number of LNs involved greater than 4 better stratify the prognosis of cases with positive LNs, except in M0 patients. LN density had no prognostic impact. In patients with LN involvement, the multivariable analysis showed an independent prognostic value for pT, M and pN1-pN2 (HR 1.57;95% IC 1.06-2.31; p=0.01) but not for the Fuhrman Grade. Conclusions This study demonstrated that in RCC the number of LNs involved correlates with prognosis, especially in patients with distant metastases. According to our data, the actual classification of nodal involvement should be modified. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e435 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Carlo Terrone More articles by this author Umberto Capitanio More articles by this author Alessandro Volpe More articles by this author Ettore Di Trapani More articles by this author Rayan Matloob More articles by this author Paolo De Angelis More articles by this author Andrea Russo More articles by this author Monica Zacchero More articles by this author Marta Fusano More articles by this author Alberto Briganti More articles by this author Roberto Tarabuzzi More articles by this author Roberto Bertini More articles by this author Francesco Montorsi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...