You have accessJournal of UrologyKidney Cancer: Advanced II1 Apr 20101800 RETROPERITONEAL LYMPH NODE METASTASIS IN M0 RENAL CELL CARCINOMA Scott Delacroix Jr, Stephen Culp, Jaclyn Jin-Ling Chen, Tamboli Pheroze, Surena Matin, and Christopher Wood Scott Delacroix JrScott Delacroix Jr More articles by this author , Stephen CulpStephen Culp More articles by this author , Jaclyn Jin-Ling ChenJaclyn Jin-Ling Chen More articles by this author , Tamboli PherozeTamboli Pheroze More articles by this author , Surena MatinSurena Matin More articles by this author , and Christopher WoodChristopher Wood More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1724AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients with renal cell carcinoma and retroperitoneal lymph node only metastasis represent a heterogeneous population for which limited prognostic data exists. Delineation of factors predicting survival as well as analysis of outcomes in the cohort would aid in deciding between upfront systemic therapy or surgical treatment. METHODS Using the M.D. Anderson Cancer Center nephrectomy database, patients without clinical evidence of distant metastasis (M0) but with pathologic positive nodes (Tany,N1-2,M0) were selected. The cohort was analyzed for predictive factors for recurrence free (RFS) and overall survival (OS). Recovery from surgery was also assessed to determine if operative disability would preclude systemic therapy in those that recurred. RESULTS Using the aforementioned criteria, 69 patients were identified. Histologic diagnosis included clear cell (47), papillary (12), unclassified (7), and chromophobe RCC (3). The overall survival (OS) of patients with TanyN+M0 was 26.0 months (95% CI:17.7-49.7) with a median follow up of 19.2 months (range, 0.3-103.9). For the entire cohort, median RFS was 6.2 months with a total of 54 patients (75.4%) having a recurrence after surgical resection. Time to recurrence was within the first 4 months after surgery for 31 patients (44.9%), between 4 and 12 months for 8 patients (11.5%), greater than a twelve months in 13 patients (18.8%), and 17 patients (24.6%) have remained disease free long term(median f/u 4.4 years). Predictors of RFS were presence of sarcomatoid features (HR 2.07-univariate), clear cell histology (HR 1.63-univariate), number of positive nodes(HR 6.56), Fuhrman grade (HR 2.77), and the presence of matted lymph nodes (HR 6.93). Predictors of OS were presence of sarcomatoid features (HR 3.23-univariate), node density (HR 1.01), grade (HR 2.22), and number of positive nodes (HR 1.09). Clinical node status and total nodes removed did not predict for either OS or RFS. Most patients, 60/69 (86.9%), maintained their functional status and were able to receive systemic upon recurrence. Rapid functional decline precluding systemic therapy occurred in 6 patients (8.8%) with early progressive disease. Mortality prior to hospital discharge occurred in 3 patients (4.3%). CONCLUSIONS For patients with isolated retroperitoneal lymph node metastasis, a majority of patients (56.6%) recur in the first year while a significant percentage (43.4%) will be surgically cured or recur after 1 year and probably derive benefit from upfront surgical therapy. In most patients, surgical resection did not preclude the use of systemic therapy. Houston, TX© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e698 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Scott Delacroix Jr More articles by this author Stephen Culp More articles by this author Jaclyn Jin-Ling Chen More articles by this author Tamboli Pheroze More articles by this author Surena Matin More articles by this author Christopher Wood More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...