EURURO Vol. 71 No. 4

Platinum Priority – Kidney Cancer

Editorial by James R. Porter on pp. 568–569 of this issue

Radical Nephrectomy With or Without Lymph Node Dissection

for Nonmetastatic Renal Cell Carcinoma: A Propensity

Score-based Analysis

Boris Gershman

a ,

R. Houston Thompson

[31_TD$DIFF][30_TD$DIFF]

Daniel M. Moreira

[31_TD$DIFF]

Stephen A. Boorjian

[31_TD$DIFF]

Matthew K. Tollefson

[31_TD$DIFF]

Christine M. Lohse

[32_TD$DIFF]

Brian A. Costello

[33_TD$DIFF]

John C. Cheville

[34_TD$DIFF]

Bradley C. Leibovich

[31_TD$DIFF]

, *

[35_TD$DIFF]

Division of Urology, Rhode Island Hospital and The Miriam Hospital, Providence, RI, USA;

Department of Urology, Mayo Clinic, Rochester, MN, USA;

[36_TD$DIFF]

Department of Urology, University of Illinois at Chicago, Chicago, IL, USA;

Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA;

[33_TD$DIFF]

Department of Oncology, Mayo Clinic, Rochester, MN, USA;

[34_TD$DIFF]

Department of

[37_TD$DIFF]

Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA

E U R O P E A N U R O L O G Y 7 1 ( 2 0 1 7 ) 5 6 0 – 5 6 7

available at

www.scienced irect.com

journal homepage:

www.europeanurology.com

Article info

Article history:

Accepted September 7, 2016

Associate Editor:

James Catto

Keywords:

Lymph node dissection

Lymphadenopathy

Nephrectomy

Renal cell carcinoma

Survival

Abstract

Background:

It is uncertain whether lymph node dissection (LND) provides a therapeu-

tic benefit in renal cell carcinoma (RCC).

Objective:

To evaluate the association of LND with oncologic outcomes among patients

undergoing radical nephrectomy (RN) for nonmetastatic RCC.

Design, setting, and participants:

A retrospective cohort study of 1797 patients treated

with RN for M0 RCC between 1990 and 2010, including 606 (34%) who underwent LND.

Intervention:

RN with or without LND.

Outcome measurements and statistical analysis:

The associations of LND with the

development of distant metastases, cancer-specific mortality (CSM), and all-cause mor-

tality (ACM) were evaluated using 1:1 propensity score (PS) matching, adjustment for/

stratification by PS quintile, and inverse probability weighting. Cox models were used to

evaluate the association of the number of lymph nodes removedwith

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oncologic outcomes.

Results and limitations:

A total of 111 (6.2%) patients were pN1. The median follow-up

after surgery was 10.6 yr. Following PS adjustment, there were no significant differences

in clinicopathologic features between patients with and without LND. In the overall

cohort, LND was not significantly associated with a reduced risk of distant metastases,

CSM, or ACM. Moreover, LND was not associated with improved oncologic outcomes

even among patients at increased risk of pN1 disease, including those with preoperative

radiographic lymphadenopathy, or across increasing threshold probabilities for pN1

disease from 0.05 to 0.50. Among patients who underwent LND, the extent of LND was

not significantly associated with the development of distant metastases, CSM, or ACM.

Limitations include the retrospective design.

Conclusions:

We did not identify an oncologic benefit to LND in the overall cohort or

among patients at increased risk of nodal disease. These findings do not support a

therapeutic benefit to LND in patients with M0 RCC.

Patient summary:

Lymph node dissection does not appear to provide a therapeutic

benefit in patients with nonmetastatic renal cell carcinoma.

* Corresponding author. Mayo Clinic, 200 First Street

[38_TD$DIFF]

SW, Rochester,

[39_TD$DIFF]

Minnesota 55905, USA.

Tel. +1-507-266-0191; Fax: +1-507-284-4951.

E-mail address:

Leibovich.Bradley@mayo.edu

(B.C. Leibovich).

http://dx.doi.org/10.1016/j.eururo.2016.09.019

0302-2838/