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- W2315888922 abstract "INTRODUCTION AND OBJECTIVES: Isolated lymph node (LN) involvement in the absence of systemic disease has historically been associated with a poor prognosis among patients with renal cell carcinoma (RCC). However, a subset of patients may have long-term survival. We examined the natural history of isolated pN1 disease and identified predictors of favorable oncologic outcomes. METHODS: Of 3830 patients with M0 RCC treated with partial or radical nephrectomy from 1980 to 2010 at Mayo Clinic, we identified 138 with isolated pN1 disease. All pathology was reviewed by one genitourinary pathologist. Metastasis-free (MFS), cancer-specific (CSS), and overall survival (OS) were estimated using the Kaplan-Meier method. Associations of clinicopathologic features with oncologic outcomes were evaluated using Cox regression models. RESULTS: Median number of positive LNs was 2 (IQR 1-3), while 57 (46%) patients had only one positive LN. Overall, 125 (91%) of patients had symptoms at presentation, 60 (43%) had preoperative radiographic lymphadenopathy (cN1), and 106 (77%) had pT3/T4 disease. Median follow-up among survivors was 8.5 years (IQR 5.6-10.9), during which time 108 patients developed distant metastases and 117 died, including 99 from RCC. MFS, CSS, and OS rates at 5/10 years were 16%/15%, 26%/21%, and 25%/15% (Figure). Median time to development of metastases was 4.2 months (IQR 2.1-11.7 months). On multivariable analysis, symptomatic presentation (HR 2.51; p1⁄40.02), radiographic IVC involvement (HR 2.03; p1⁄40.002), pT4 stage (HR 2.56; p1⁄40.006), adverse histologic subtype (HR 2.34; p1⁄40.005), and coagulative tumor necrosis (HR 2.59; p<0.001) were independently associated with development of metastases. Interestingly, the number of positive LNs was not associated with oncologic outcomes. CONCLUSIONS: Isolated pN1 disease portends an ominous prognosis, with only 16% of patients free of distant metastases at 5years after surgery. Nevertheless, this subset does have long-term survival at 10-years. In those patients who progressed, the majority (77%) of metastases occurred within 1 year of surgery. Symptoms at presentation, radiographic IVC involvement, and pT4 stage were independently associated with development of distant metastases and may enhance patient risk stratification and counseling." @default.
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- W2315888922 date "2016-04-01" @default.
- W2315888922 modified "2023-09-25" @default.
- W2315888922 title "PD04-01 RENAL CELL CARCINOMA WITH ISOLATED LYMPH NODE INVOLVEMENT: NATURAL HISTORY AND PREDICTORS OF ONCOLOGIC OUTCOMES" @default.
- W2315888922 doi "https://doi.org/10.1016/j.juro.2016.02.2406" @default.
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