The natural history of renal cell carcinoma with isolated lymph node metastases following surgical resection from 2006 to 2013

Borivoj Golijanin, Jorge Pereira, Catrina Mueller-Leonhard, Dragan Golijanin, Ali Amin, Anthony Mega, Stephen A. Boorjian, R. Houston Thompson, Bradley C. Leibovich, Boris Gershman

Research output: Contribution to journalArticle

Abstract

Introduction: Renal cell carcinoma (RCC) with isolated lymph node (LN) involvement (pN1 M0 RCC) is a rare clinical entity associated with a poor prognosis. Prior studies comprised cohorts treated predominantly prior to the introduction of targeted systemic therapy. We therefore examined the natural history of pN1M0 RCC following surgical resection in a contemporary cohort, and evaluated clinicopathologic features associated with survival. Patients and methods: We identified patients aged 18 to 89 years who underwent radical or partial nephrectomy with LN dissection for pN1 M0 RCC from 2006 to 2013 in the National Cancer Database. The associations of clinicopathologic features with overall survival (OS) were evaluated using Cox regression models, and a simplified risk score was developed. Results: A total of 2,679 patients were found to have pN1 M0 RCC after nephrectomy. Median follow-up was 19.2 (interquartile range 8.2, 39.8) months, during which time 1,782 patients died. One-, 5-, and 8-year OS rates were 68%, 28%, and 19%, respectively. On multivariable analysis, older age (HR 1.50; P< 0.001 for ≥70 vs, 18–<50 years old), rural location (HR 1.49; P= 0.01), larger tumor size (HR 1.29; P= 0.01 for 5–<10 cm; HR 1.34; P= 0.01 for 10–<15 cm; HR 1.43; P= 0.01 for ≥15 cm vs. <5 cm); higher pT stage (HR 1.25; P= 0.04 for pT3; HR 2.41; P< 0.001 for pT4 vs. pT1), positive surgical margins (HR 1.55; P< 0.001), number of positive LNs (HR 1.18; P= 0.01 for 2–3; HR 1.37; P< 0.001 for >3 vs. 1), and nonclear cell histologic subtype (HR 1.32; P< 0.001) were independently associated with decreased OS. A simplified risk score was developed based on the multivariable results. Five-year OS was 49%, 28%, 22%, and 10% for patients with scores of <4, 4 to 6, 7 to 9, and >9, respectively. Conclusions: In this large, contemporary cohort, pN1 M0 RCC was associated with a poor prognosis, with 5-year survival less than 30%. A simplified risk score was developed to facilitate postoperative risk-stratification and selection of patients for consideration of adjuvant therapy and clinical trial enrollment.

Original languageEnglish (US)
JournalUrologic Oncology: Seminars and Original Investigations
DOIs
StateAccepted/In press - Jan 1 2019

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Renal Cell Carcinoma
Lymph Nodes
Neoplasm Metastasis
Nephrectomy
Survival
Lymph Node Excision
Natural History
Proportional Hazards Models
Patient Selection
Cohort Studies
Survival Rate
Clinical Trials
Databases
Therapeutics
Neoplasms

Keywords

  • Lymph nodes
  • Lymphadenectomy
  • Metastasis
  • Renal cell carcinoma
  • Targeted therapy

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

The natural history of renal cell carcinoma with isolated lymph node metastases following surgical resection from 2006 to 2013. / Golijanin, Borivoj; Pereira, Jorge; Mueller-Leonhard, Catrina; Golijanin, Dragan; Amin, Ali; Mega, Anthony; Boorjian, Stephen A.; Thompson, R. Houston; Leibovich, Bradley C.; Gershman, Boris.

In: Urologic Oncology: Seminars and Original Investigations, 01.01.2019.

Research output: Contribution to journalArticle

Golijanin, Borivoj ; Pereira, Jorge ; Mueller-Leonhard, Catrina ; Golijanin, Dragan ; Amin, Ali ; Mega, Anthony ; Boorjian, Stephen A. ; Thompson, R. Houston ; Leibovich, Bradley C. ; Gershman, Boris. / The natural history of renal cell carcinoma with isolated lymph node metastases following surgical resection from 2006 to 2013. In: Urologic Oncology: Seminars and Original Investigations. 2019.
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title = "The natural history of renal cell carcinoma with isolated lymph node metastases following surgical resection from 2006 to 2013",
abstract = "Introduction: Renal cell carcinoma (RCC) with isolated lymph node (LN) involvement (pN1 M0 RCC) is a rare clinical entity associated with a poor prognosis. Prior studies comprised cohorts treated predominantly prior to the introduction of targeted systemic therapy. We therefore examined the natural history of pN1M0 RCC following surgical resection in a contemporary cohort, and evaluated clinicopathologic features associated with survival. Patients and methods: We identified patients aged 18 to 89 years who underwent radical or partial nephrectomy with LN dissection for pN1 M0 RCC from 2006 to 2013 in the National Cancer Database. The associations of clinicopathologic features with overall survival (OS) were evaluated using Cox regression models, and a simplified risk score was developed. Results: A total of 2,679 patients were found to have pN1 M0 RCC after nephrectomy. Median follow-up was 19.2 (interquartile range 8.2, 39.8) months, during which time 1,782 patients died. One-, 5-, and 8-year OS rates were 68{\%}, 28{\%}, and 19{\%}, respectively. On multivariable analysis, older age (HR 1.50; P< 0.001 for ≥70 vs, 18–<50 years old), rural location (HR 1.49; P= 0.01), larger tumor size (HR 1.29; P= 0.01 for 5–<10 cm; HR 1.34; P= 0.01 for 10–<15 cm; HR 1.43; P= 0.01 for ≥15 cm vs. <5 cm); higher pT stage (HR 1.25; P= 0.04 for pT3; HR 2.41; P< 0.001 for pT4 vs. pT1), positive surgical margins (HR 1.55; P< 0.001), number of positive LNs (HR 1.18; P= 0.01 for 2–3; HR 1.37; P< 0.001 for >3 vs. 1), and nonclear cell histologic subtype (HR 1.32; P< 0.001) were independently associated with decreased OS. A simplified risk score was developed based on the multivariable results. Five-year OS was 49{\%}, 28{\%}, 22{\%}, and 10{\%} for patients with scores of <4, 4 to 6, 7 to 9, and >9, respectively. Conclusions: In this large, contemporary cohort, pN1 M0 RCC was associated with a poor prognosis, with 5-year survival less than 30{\%}. A simplified risk score was developed to facilitate postoperative risk-stratification and selection of patients for consideration of adjuvant therapy and clinical trial enrollment.",
keywords = "Lymph nodes, Lymphadenectomy, Metastasis, Renal cell carcinoma, Targeted therapy",
author = "Borivoj Golijanin and Jorge Pereira and Catrina Mueller-Leonhard and Dragan Golijanin and Ali Amin and Anthony Mega and Boorjian, {Stephen A.} and Thompson, {R. Houston} and Leibovich, {Bradley C.} and Boris Gershman",
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T1 - The natural history of renal cell carcinoma with isolated lymph node metastases following surgical resection from 2006 to 2013

AU - Golijanin, Borivoj

AU - Pereira, Jorge

AU - Mueller-Leonhard, Catrina

AU - Golijanin, Dragan

AU - Amin, Ali

AU - Mega, Anthony

AU - Boorjian, Stephen A.

AU - Thompson, R. Houston

AU - Leibovich, Bradley C.

AU - Gershman, Boris

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction: Renal cell carcinoma (RCC) with isolated lymph node (LN) involvement (pN1 M0 RCC) is a rare clinical entity associated with a poor prognosis. Prior studies comprised cohorts treated predominantly prior to the introduction of targeted systemic therapy. We therefore examined the natural history of pN1M0 RCC following surgical resection in a contemporary cohort, and evaluated clinicopathologic features associated with survival. Patients and methods: We identified patients aged 18 to 89 years who underwent radical or partial nephrectomy with LN dissection for pN1 M0 RCC from 2006 to 2013 in the National Cancer Database. The associations of clinicopathologic features with overall survival (OS) were evaluated using Cox regression models, and a simplified risk score was developed. Results: A total of 2,679 patients were found to have pN1 M0 RCC after nephrectomy. Median follow-up was 19.2 (interquartile range 8.2, 39.8) months, during which time 1,782 patients died. One-, 5-, and 8-year OS rates were 68%, 28%, and 19%, respectively. On multivariable analysis, older age (HR 1.50; P< 0.001 for ≥70 vs, 18–<50 years old), rural location (HR 1.49; P= 0.01), larger tumor size (HR 1.29; P= 0.01 for 5–<10 cm; HR 1.34; P= 0.01 for 10–<15 cm; HR 1.43; P= 0.01 for ≥15 cm vs. <5 cm); higher pT stage (HR 1.25; P= 0.04 for pT3; HR 2.41; P< 0.001 for pT4 vs. pT1), positive surgical margins (HR 1.55; P< 0.001), number of positive LNs (HR 1.18; P= 0.01 for 2–3; HR 1.37; P< 0.001 for >3 vs. 1), and nonclear cell histologic subtype (HR 1.32; P< 0.001) were independently associated with decreased OS. A simplified risk score was developed based on the multivariable results. Five-year OS was 49%, 28%, 22%, and 10% for patients with scores of <4, 4 to 6, 7 to 9, and >9, respectively. Conclusions: In this large, contemporary cohort, pN1 M0 RCC was associated with a poor prognosis, with 5-year survival less than 30%. A simplified risk score was developed to facilitate postoperative risk-stratification and selection of patients for consideration of adjuvant therapy and clinical trial enrollment.

AB - Introduction: Renal cell carcinoma (RCC) with isolated lymph node (LN) involvement (pN1 M0 RCC) is a rare clinical entity associated with a poor prognosis. Prior studies comprised cohorts treated predominantly prior to the introduction of targeted systemic therapy. We therefore examined the natural history of pN1M0 RCC following surgical resection in a contemporary cohort, and evaluated clinicopathologic features associated with survival. Patients and methods: We identified patients aged 18 to 89 years who underwent radical or partial nephrectomy with LN dissection for pN1 M0 RCC from 2006 to 2013 in the National Cancer Database. The associations of clinicopathologic features with overall survival (OS) were evaluated using Cox regression models, and a simplified risk score was developed. Results: A total of 2,679 patients were found to have pN1 M0 RCC after nephrectomy. Median follow-up was 19.2 (interquartile range 8.2, 39.8) months, during which time 1,782 patients died. One-, 5-, and 8-year OS rates were 68%, 28%, and 19%, respectively. On multivariable analysis, older age (HR 1.50; P< 0.001 for ≥70 vs, 18–<50 years old), rural location (HR 1.49; P= 0.01), larger tumor size (HR 1.29; P= 0.01 for 5–<10 cm; HR 1.34; P= 0.01 for 10–<15 cm; HR 1.43; P= 0.01 for ≥15 cm vs. <5 cm); higher pT stage (HR 1.25; P= 0.04 for pT3; HR 2.41; P< 0.001 for pT4 vs. pT1), positive surgical margins (HR 1.55; P< 0.001), number of positive LNs (HR 1.18; P= 0.01 for 2–3; HR 1.37; P< 0.001 for >3 vs. 1), and nonclear cell histologic subtype (HR 1.32; P< 0.001) were independently associated with decreased OS. A simplified risk score was developed based on the multivariable results. Five-year OS was 49%, 28%, 22%, and 10% for patients with scores of <4, 4 to 6, 7 to 9, and >9, respectively. Conclusions: In this large, contemporary cohort, pN1 M0 RCC was associated with a poor prognosis, with 5-year survival less than 30%. A simplified risk score was developed to facilitate postoperative risk-stratification and selection of patients for consideration of adjuvant therapy and clinical trial enrollment.

KW - Lymph nodes

KW - Lymphadenectomy

KW - Metastasis

KW - Renal cell carcinoma

KW - Targeted therapy

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