Login to Access Video or Poster Abstract: MP16-09
Sources of Funding: None

Introduction

The potential benefit of extended lymphadenectomy (eLND) for advanced renal malignancy remains controversial. We aimed to assess contemporary survival outcomes associated with eLND performed for kidney cancer patients.

Methods

Using Surveillance, Epidemiology, End Results (SEER) data, we identified patients with non-metastatic renal cancer (2004-2013) treated with nephrectomy with 1+ lymph nodes removed. Our primary exposure was extended lymphadenectomy, defined by 10+ lymph nodes removed. Outcomes of interest included 5- and 9-year cancer-specific (CSS) and overall survival (OS). Other covariates of interest included patient age, sex, race/ethnicity, marital status, year of diagnosis, tumor stage, tumor grade, nodal stage and tumor histology. Kaplan-Meier analyses and Cox proportional hazard models were generated to compare survival outcomes based on covariates and primary exposure of interest. Patients with missing tumor data were excluded from regression analyses.

Results

Among 66,013 kidney cancer patients treated with extirpative surgery, 7,523 (11.4%) had 1+ lymph nodes removed. The median lymph node count was 2 (IQR 1-6). Of this group, 1,031 (13.7%) patients had an eLND. Use of eLND was associated with advanced tumor stage and higher tumor grade (both p<0.001). Nine-year CSS and OS for eLND patients was 66.5% (vs 69.1% non-eLND, p=0.01) and 58.5% (vs 56.3% non-eLND, p=0.29), respectively. Among node-positive patients, 5-year CSS and OS with eLND were 40.0% (vs 34.3% non-eLND, p=0.55) and 33.1% (vs 28.4% non-eLND, p=0.73), respectively. After adjusting for confounding factors, Cox proportional hazard models estimated a significant OS benefit associated with eLND (adjusted hazard ratio (HR) 0.86, 95% Confidence Interval (CI) 0.74 - 0.99, p=0.04). Differences in CSS did not reach statistical significance overall (HR 0.88, 95% CI 0.74 - 1.03, p=0.11), but a CSS advantage was seen among node-positive patients (HR 0.70, 95% CI 0.52 - 0.97, p=0.03).

Conclusions

Extended lymphadenectomy may provide a survival benefit among patients with advanced renal cell carcinoma.

Funding

None