Publication
Characterizing the Impact of Lymph Node Metastases on the Survival Outcome for Metastatic Renal Cell Carcinoma Patients Treated with Targeted Therapies
Journal Paper/Review - Dec 15, 2014
Kroeger Nils, Smoragiewicz Martin, Lee Jae, Rini Brian I, Vaishampayan Ulka N, Wood Lori A, Beuselinck Benoit, Donskov Frede, Choueiri Toni K, Bernstein Ezra, Knox Jennifer, Templeton Arnoud, Pantuck Allan J, Wells J Connor, Lawrence Nicola, Broom Reuben, Kim Jenny J, Srinivas Sandy, Yim Jessica, Bjarnason Georg A, Heng Daniel Y
Units
PubMed
Doi
Citation
Type
Journal
Publication Date
Issn Electronic
Brief description/objective
BACKGROUND
It is unknown whether lymph node metastases (LNM) and their localization negatively affect clinical outcome in metastatic renal cell carcinoma (mRCC) patients.
OBJECTIVE
To evaluate the clinicopathological features, survival outcome, and treatment response in mRCC patients with LNM versus those without LNM after treatment with targeted therapies (TT).
DESIGN, SETTING, AND PARTICIPANTS
Patients (n=2996) were first analyzed without consideration of lymph node (LN) localization or histologic subtype. Additional analyses (n=1536) were performed in subgroups of patients with supradiaphragmatic (SPD) LNM, subdiaphragmatic (SBD) LNM, and patients with LNM in both locations (SPD+/SBD+) without histologic considerations, and then separately in clear cell RCC (ccRCC) and non-clear cell RCC (nccRCC) patients, respectively.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
The primary outcome was overall survival (OS) and the secondary outcome was progression-free survival (PFS).
RESULTS AND LIMITATIONS
All patients with LNM had worse PFS (p=0.001) and OS (p<0.001) compared to those without LNM. Compared to patients without LNM (PFS 8.8 mo; OS 25.1 mo), any SBD LNM involvement was associated with worse PFS (SBD, 6.8 mo; p=0.003; SPD+/SBD+, 5.5 mo; p<0.001) and OS (SBD, 16.2 mo; p<0.001; SPD+/SBD+, 11.5 mo; p<0.001). Both SBD and SPD+/SBD+ LNM were retained as independent prognostic factors in multivariate analyses (MVA) for PFS (p=0.006 and p=0.022, respectively) and OS (both p<0.001), while SPD LNM was not an independent risk factor. Likewise, in ccRCC, SBD LNM (19.8 mo) and SPD+/SBD+ LNM (12.85 mo) patients had the worst OS. SPD+/SBD+ LNM (p=0.006) and SBD LNM (p=0.028) were independent prognostic factors for OS in MVA, while SPD LNM was not significant (p=0.301). The study is limited by its retrospective design and the lack of pathologic evaluation of LNM in all cases.
CONCLUSIONS
The metastatic spread of RCC to SBD lymph nodes is associated with poor prognosis in mRCC patients treated with TT.
PATIENT SUMMARY
The presence of lymph node metastases below the diaphragm is associated with shorter survival outcome when metastatic renal cell carcinoma (mRCC) patients are treated with targeted therapies. Clinical trials should evaluate whether surgical removal of regional lymph nodes at the time of nephrectomy may improve outcomes in high-risk RCC patients.