Introduction

Patients with locally advanced (pT3) renal cell carcinoma (RCC) and pathologic nodal disease may have worse survival than those without nodal disease, although they are currently all considered stage III. Our aim was to compare the survival of stage III RCC patients with pathologic nodal disease (pT123N1M0) to stage III patients without nodal disease (pT3N0M0), and stage IV patients.

Methods

We retrospectively studied a cohort of patients who underwent retroperitoneal lymph node dissection at the time of nephrectomy from 1993 to 2012. Stage III with (pT123N1M0) and without (pT3abcN0M0) pathologic nodal disease was noted in 115 (7.7%) and 275 (18.4%) patients. In order to compare outcomes of stage III patients to those with stage IV disease, we included 523 pT123N0M1 and 222 pTanyN1M1 patients. Cancer-specific survival (CSS) was estimated using the Kaplan-Meier Method. Univariate and multivariate Cox proportional hazards regression models were fit to identify factors significantly associated with clinical outcomes.

Results

Clear cell RCC was present in 86.9% and 60.0%, and high grade tumor (grade 4) was present in 26.5% and 50.4% of pT3N0 and pT123N1, respectively. Median tumor size was 9 cm and 10 cm in pT3N0 and pT123N1 patients, and median number of lymph nodes removed was 6 (range1-45) and 8 (range1-37), respectively. Cancer-specific survival was better in patients with pT3abcN0M0 than those with pT123N1M0 (5-year CSS rate: 74.8% vs 38.6%, p<0.001); however, similar 5-year CSS rates were noted in pN1M0 and pN0M1 (38.6% vs 29.8%, p=0.13), while pTanyN1M1 had the worst 5-year CSS (7%). On multivariate Cox regression analysis, high-grade tumor (HR 2.96, 95% CI 2.11-4.14, p<0.0001), and pathologic lymph node involvement (HR 2.83, 95% CI 2.03-3.95, p<0.0001) were significantly associated with cancer-specific survival.

Conclusions

Patients with pN1M0 disease have significantly worse survival than those with pT3N0M0 disease, although both groups are currently classified as stage III. In addition, patients with pN1M0 have survival similar to those with pN0M1 disease (stage IV), suggesting that pN1M0 patients should be reclassified as stage IV.

Funding

none