Extranodal Extension in Regional Lymph Nodes is Associated With Outcome in Patients With Renal Cell Carcinoma
- 30 November 2006
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Urology
- Vol. 176 (5), 1978-1983
- https://doi.org/10.1016/j.juro.2006.07.026
Abstract
Purpose: The 2002 American Joint Committee on Cancer pN classification for renal cell carcinoma is based on the number of positive regional lymph nodes. We examined the associations of pathological features of lymph node metastases with patient outcome to improve the prognostic accuracy of the current classification. Materials and Methods: We studied the records of 2,076 patients treated with radical nephrectomy for unilateral, sporadic pM0 renal cell carcinoma between 1970 and 2000. There were 34 patients with metastasis in a single regional lymph node (pN1) and 35 with metastases in more than 1 lymph node (pN2). Pathological features of lymph node metastases, including the number and percent of positive lymph nodes, total number of lymph nodes removed, grade, necrosis, extranodal extension, and largest dimension and surface area of metastases were determined by 2 urological pathologists (HHD and JCC). Results: There was no statistically significant association between the pN classification and death from renal cell carcinoma (pN2 vs pN1 RR 1.05, 95% CI 0.62 to 1.79, p = 0.846). However, patients with extranodal extension were twice as likely to die of renal cell carcinoma than patients in whom metastases did not extend outside of the lymph node capsule (RR 2.02, 95% CI 1.18 to 3.45, p = 0.010). The 5-year cancer specific survival rate was 18% and 35% in patients with and without extranodal extension, respectively. Conclusions: We believe that a pN classification based on the presence or absence of lymph node metastases with a notation regarding the presence or absence of extranodal extension represents a significant improvement in the prognostic accuracy of the current pN classification.Keywords
This publication has 16 references indexed in Scilit:
- Reclassification of patients with pT3 and pT4 renal cell carcinoma improves prognostic accuracyCancer, 2005
- A PROTOCOL FOR PERFORMING EXTENDED LYMPH NODE DISSECTION USING PRIMARY TUMOR PATHOLOGICAL FEATURES FOR PATIENTS TREATED WITH RADICAL NEPHRECTOMY FOR CLEAR CELL RENAL CELL CARCINOMAJournal of Urology, 2004
- The process for continuous improvement of the TNM classificationCancer, 2003
- Reassessment of the 1997 TNM classification system for renal cell carcinomaCancer, 2003
- Renal cell carcinoma with retroperitoneal lymph nodesCancer, 2003
- TNM T3a Renal Cell Carcinoma: Adrenal Gland Involvement is Not the Same as Renal Fat InvasionJournal of Urology, 2003
- An Outcome Prediction Model for Patients with Clear Cell Renal Cell Carcinoma Treated with Radical Nephrectomy Based on Tumor Stage, Size, Grade and Necrosis: The Ssign ScoreJournal of Urology, 2002
- Comparison of Standardized and Nonstandardized Nuclear Grade of Renal Cell Carcinoma to Predict Outcome Among 2,042 PatientsAmerican Journal of Clinical Pathology, 2002
- A POSTOPERATIVE PROGNOSTIC NOMOGRAM FOR RENAL CELL CARCINOMAJournal of Urology, 2001
- REEVALUATION OF THE 1997 TNM CLASSIFICATION FOR RENAL CELL CARCINOMA: T1 AND T2 CUTOFF POINT AT 4.5 RATHER THAN 7 CM. BETTER CORRELATES WITH CLINICAL OUTCOMEJournal of Urology, 2001