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- Title
Renal cell carcinoma and pathologic nodal disease: Implications for American Joint Committee on Cancer staging.
- Authors
Yu, Kai‐Jie; Keskin, Sarp K.; Meissner, Matthew A.; Petros, Firas G.; Wang, Xuemei; Borregales, Leonardo D.; Gu, Cindy; Tamboli, Pheroze; Matin, Surena F.; Wood, Christopher G.; Karam, Jose A.; Yu, Kai-Jie
- Abstract
<bold>Background: </bold>Lymph node (LN) metastases are associated with poor outcomes for patients with renal cell carcinoma (RCC). This study compared the survival outcomes of patients with stage III, node-positive disease (pT123 N1 M0 ) and patients with stage III, node-negative disease (pT3 N0 M0 ).<bold>Methods: </bold>A database of 4652 patients with RCC of any histological subtype treated with surgery at The University of Texas MD Anderson Cancer Center from 1993 to 2012 was retrospectively assessed. A total of 115 patients with pT123 N1 M0 disease, 274 patients with pT3 N0 M0 disease, and 523 patients with pT123 N0/x M1 disease were included. Overall survival (OS) and cancer-specific survival (CSS) were estimated and compared between each cohort.<bold>Results: </bold>Median OS and CSS times were significantly better for pT3 N0 M0 patients than pT123 N1 M0 patients (OS, 10.2 vs 2.4 years, P < .0001; CSS, not reached vs 2.8 years, P < .0001). Similar median OS and CSS times were noted for pT123 N1 M0 and pT123 N0/x M1 patients (OS, 2.4 vs 2.4 years; P = .62; CSS, 2.8 vs 2.4 years; P = .10). In a multivariate analysis, tumor grade (hazard ratio [HR] for OS, 2.47; P < .0001; HR for CSS, 2.99; P < .0001) and pathologic LN involvement (HR for OS, 2.44; P < .0001; HR for CSS, 2.85; P < .0001) were associated with worse OS and CSS.<bold>Conclusions: </bold>Among RCC patients classified with stage III disease, those with pT123 N1 M0 disease had significantly worse survival than those with pT3 N0 M0 disease. OS and CSS were similar for patients with pT123 N1 M0 disease and patients with pT123 N0/x M1 disease (stage IV). If validated, these findings suggest that RCC patients with nodal disease should be reclassified as having stage IV disease.
- Subjects
UNITED States; RENAL cell carcinoma; LYMPH node cancer; METASTASIS; NEPHRECTOMY; RENAL cancer; CANCER treatment; COMPARATIVE studies; DATABASES; KIDNEY tumors; RESEARCH methodology; MEDICAL cooperation; MEDICAL societies; ONCOLOGY; PROGNOSIS; RESEARCH; SURVIVAL analysis (Biometry); TUMOR classification; EVALUATION research; RETROSPECTIVE studies; STANDARDS; TUMOR treatment
- Publication
Cancer (0008543X), 2018, Vol 124, Issue 20, p4023
- ISSN
0008-543X
- Publication type
journal article
- DOI
10.1002/cncr.31661