Impact of lymph node dissection at the time of radical nephrectomy with tumor thrombectomy on oncological outcomes: Results from the International Renal Cell Carcinoma-Venous Thrombus Consortium (IRCC-VTC)

Autor: Thenappan Chandrasekar, Siamak Daneshmand, Martin Spahn, Christopher P. Evans, Shahrokh F. Shariat, Juan Palou, Cesar D. Vera-Donoso, James M. McKiernan, Francesco Montorsi, Richard Zigeuner, Raj S. Pruthi, Viraj A. Master, Adam Lorentz, Paolo Gontero, Oscar Rodriguez-Faba, Giacomo Novara, Paul Russo, Douglas S. Scherr, Carlo Terrone, Sascha Pahernik, Axel Haferkamp, Gaetano Ciancio, Juan Ignacio Martínez-Salamanca, Javier Carrascosa González, Estefanía Linares Espinós, John A. Libertino, William C. Huang, Markus Hohenfellner, Derya Tilki, Umberto Capitanio
Přispěvatelé: Tilki, Derya, Chandrasekar, Thenappan, Capitanio, Umberto, Ciancio, Gaetano, Daneshmand, Siamak, Gontero, Paolo, Gonzalez, Javier, Haferkamp, Axel, Hohenfellner, Marku, Huang, William C., Linares Espinós, Estefania, Lorentz, Adam, Martinez-Salamanca, Juan I., Master, Viraj A., Mckiernan, James M., Montorsi, Francesco, Novara, Giacomo, Pahernik, Sascha, Palou, Juan, Pruthi, Raj S., Rodriguez-Faba, Oscar, Russo, Paul, Scherr, Douglas S., Shariat, Shahrokh F., Spahn, Martin, Terrone, Carlo, Vera-Donoso, Cesar, Zigeuner, Richard, Libertino, John A., Evans, Christopher P.
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Male
Kidney Disease
Outcome Assessment
Survival
medicine.medical_treatment
030232 urology & nephrology
Nephrectomy
Metastasis
0302 clinical medicine
Renal cell carcinoma
Vena cava tumor thrombectomy
Outcome Assessment
Health Care
Inferior vena cava
610 Medicine & health
Lymph node
Cancer
Thrombectomy
Urology & Nephrology
Middle Aged
Kidney Neoplasms
Dissection
medicine.anatomical_structure
medicine.vein
Oncology
030220 oncology & carcinogenesis
Female
medicine.medical_specialty
Urology
Oncology and Carcinogenesis
Article
Lymph node metastasi
03 medical and health sciences
Rare Diseases
medicine
Humans
Thrombus
Carcinoma
Renal Cell
Aged
Proportional Hazards Models
Lymph node metastasis
business.industry
Carcinoma
Renal Cell
Thrombosis
Lymphadenectomy
medicine.disease
Survival Analysis
Surgery
Health Care
Lymph Node Excision
Lymph Nodes
business
Zdroj: Urol Oncol
Urologic oncology, vol 36, iss 2
UROLOGIC ONCOLOGY-SEMINARS AND ORIGINAL INVESTIGATIONS
r-IIS La Fe. Repositorio Institucional de Producción Científica del Instituto de Investigación Sanitaria La Fe
instname
r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
ISSN: 1078-1439
Popis: Objectives: To study the effect of lymph node dissection (LND) at the time of nephrectomy and tumor thrombectomy on oncological outcomes in patients with renal cell carcinoma (RCC) and tumor thrombus. Patients and methods: The records of 1,978 patients with RCC and tumor thrombus who underwent radical nephrectomy and tumor thrombectomy from 1985 to 2014 at 24 centers were analyzed. None of the patients had distant metastases. Extent and pathologic results of LND were compared with respect to cancer-specific survival (CSS). Multivariable Cox regression models were used to quantify the effect of multiple covariates. Results: LND was performed in 1,026 patients. In multivariable analysis, the presence of LN metastasis, the number of positive LNs, and LN density were independently associated with cancer-specific mortality (CSM). Clinical node-negative (cN-) disease was documented in 573 patients, 447 of them underwent LND with 43 cN- patients (9.6%) revealing positive LNs at pathology. LN positive cN- patients showed significantly better CSS when compared to LN positive cN+ patients. In multivariable analysis, positive cN status in LN positive patients was a significant predictor of CSM (HR, 2.923; P = 0.015). Conclusions: The number of positive nodes harvested during LND and LN density was strong prognostic indicators of CSS, while number of removed LNs did not have a significant effect on CSS. The rate of pN1 patients among clinically node-negative patients was relatively high, and LND in these patients suggested a survival benefit. However, only a randomized trial can determine the absolute benefit of LND in this setting. Copyright (C) 2018 Elsevier Inc. All rights reserved.
Databáze: OpenAIRE
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