Introduction

The role of lymph node dissection (LND) in the management of renal cell carcinoma (RCC) has been controversial, with conflicting data regarding its oncologic benefit. Proponents of LND have suggested that it may benefit patients at increased risk of lymph node (LN) metastases, which prior studies may have been underpowered to detect. We therefore utilized a large, multi-institutional cohort to evaluate the association of LND with survival among patients undergoing RN for RCC.

Methods

We identified 2,722 patients who underwent RN for M0 RCC between 1990 and 2010 at Mayo Clinic and San Raffaele Scientific Institute, including 1,215 (45%) with concomitant LND. A propensity score (PS) for receipt of LND was constructed using clinicopathologic features. The associations of LND with development of distant metastases, cancer-specific mortality (CSM), and all-cause mortality (ACM) were evaluated using Cox regression models adjusted for PS quintile or stabilized inverse probability weights (IPW). Internally predicted probabilities for pN1 disease were estimated using logistic regression.

Results

Overall, 171 (6.3%) patients were pN1. There were no statistically significant differences in clinicopathologic features stratified by LND after PS adjustment. Median follow-up among survivors was 9.6 years, during which time 787 patients developed distant metastases and 622 died from RCC. Overall, LND was not significantly associated with a reduced risk of distant metastases, CSM, or ACM using any of the PS techniques (Table). More importantly, we examined the association of LND with oncologic outcomes among patients at increased risk of pN1 disease. Here, LND was not associated with oncologic outcomes among patients with preoperative radiographic lymphadenopathy (cN1), and no consistent association with improved oncologic outcomes was noted across increasing probability thresholds for pN1 disease from 0.10 to 0.50.

Conclusions

The current analysis of a large, international cohort indicates that LND is not associated with improved oncologic outcomes among patients undergoing RN for M0 RCC, including patients at increased risk of LN metastases such as those with radiographic lymphadenopathy (cN1) or across increasing probability thresholds for pN1 disease. _x000D_

Funding

None