Abstract:Objective: To assess the prognostic factors related to positive lymph nodes for renal cell carcinoma (RCC) with enlarged lymph nodes, since use of lymph node dissection in these patients was debatable. Methods: We retrospectively reviewed the clinicopathologic data of 328 patients with RCC who underwent radical nephrectomy (RN) and the enlarged lymph nodes were confirmed preoperatively or perioperatively. These patients were treated at the PLA General Hospital from January 2006 to December 2014. A multivariate logistic regression model was used to determine the clinicopathologic features of the primary tumor that were associated with positive regional lymph nodes at RN. Results: Younger age, distant metastasis, high nuclear grade, high tumor stage, and renal capsule invasion were significantly associated with positive lymph nodes in a multivariate setting. Conclusions: Younger age, distant metastasis, high nuclear grade, high tumor stage, and renal capsule invasion are the high risk factors for lymph node involvement at RN in RCC patients with enlarged lymph nodes.
[1]Ljungberg B, Bensalah K, Canfield S, et al. EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol, 2015,67 (5):913-924. [2]Ward JF, Blute ML, Cheville JC, et al. The influence of pNx/pN0 grouping in a multivariate setting for outcome modeling in patients with clear cell renal cell carcinoma. J Urol, 2002,168 (1):56-60. [3]Giberti C, Oneto F, Martorana G, et al. Radical nephrectomy for renal cell carcinoma: long-term results and prognostic factors on a series of 328 cases. Eur Urol,1997,31(4):40-48. [4]Geller JI, Dome JS. Local lymph node involvement does not predict poor outcome in pediatric renal cell carcinoma. Cancer, 2004,101(7):1575-1583. [5]Pantuck AJ, Zisman A, Dorey F, et al. Renal cell carcinoma with retroperitoneal lymph nodes: role of lymph node dissection. J Urol, 2003,169(6):2076-2083. [6]Fantini J, Rognoni JB, Theveniau M, et al. Impaired carcinoembryonic antigen release during the process of suramin-induced differentiation of the human colonic adenocarcinoma cell clone HT29-D4. J Cell Physiol, 1990,143( 3):468-474. [7]Blom JH, van Poppel H, Marechal JM, et al. Radical nephrectomy with and without lymph node dissection: preliminary results of the EORTC randomized phase III protocol 30881. EORTC Genitourinary Group. Eur Urol,1999,36 (6):570-575. [8]Phillips CK, Taneja SS. The role of lymphadenectomy in the surgical management of renal cell carcinoma. Urol Oncol, 2004,22(3):214-224. [9]Wood CG. The role of cytoreductive nephrectomy in the management of metastatic renal cell carcinoma. Urol Clin North Am, 2003,30(3):581-588. [10]Mickisch GH, Garin A, van Poppel H, et al. European Organisation for Research and Treatment of Cancer (EORTC) Genitourinary Group. Radical nephrectomy plus interferon-alfa-based immunotherapy compared with interferon alfa alone in metastatic renal-cell carcinoma: A randomised trial. Lancet, 2001,358(9286):966-970. [11]Blute ML, Leibovich BC, Cheville JC, et al. A protocol for performing extended lymph node dissection using primary tumor pathological features for patients treated with radical nephrectomy for clear cell renal cell carcinoma. J Urol, 2004,172(2):465-469. [12]Terrone C, Guercio S, De Luca S, et al. The number of lymph nodes examined and staging accuracy in renal cell carcinoma. BJU Int, 2003,91(1):37-40.