Timing and distribution of early renal cell carcinoma recurrences stratified by pathological nodal status in M0 patients at the time of nephrectomy.

Publisher: Blackwell Science Asia Country of Publication: Australia NLM ID: 9440237 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1442-2042 (Electronic) Linking ISSN: 09198172 NLM ISO Abbreviation: Int J Urol Subsets: MEDLINE

Publication: Carlton South, Vic. : Blackwell Science Asia
Original Publication: Tokyo ; New York : Churchill Livingstone, c1994-

Carcinoma, Renal Cell*/surgery ; Kidney Neoplasms*/surgery; Humans ; Lymph Node Excision ; Lymph Nodes/surgery ; Lymphatic Metastasis ; Neoplasm Recurrence, Local/epidemiology ; Nephrectomy ; Prognosis ; Retrospective Studies

Objectives: To evaluate the timing and distribution of first renal cell carcinoma metastasis after nephrectomy stratified by nodal status.
Methods: We evaluated patients treated with nephrectomy for sporadic, unilateral renal cell carcinoma between 1970 and 2011 who subsequently developed distant metastasis to three or fewer sites. Site-specific metastases-free 2-year survival rates were estimated using the Kaplan-Meier method. Associations of nodal status with time to metastasis were evaluated using multivariable Cox regression models.
Results: A total of 1049 patients met the inclusion criteria (135 pN1, 914 pN0/x patients). The median time to identification of first distant metastasis for pN1 patients was 0.4 years (interquartile range 0.2-1.1 years) versus 2.2 years (interquartile range 0.6-6.0 years) in pN0/x patients. The most common site of metastasis was to the lung, but this occurred earlier in pN1 patients (median 0.3 years vs 2.0 years). pN1 was associated with significantly lower site-specific 2-year metastases-free survival when compared with pN0/x for lung (37% vs 70%, P < 0.001), bone (63% vs 87%, P < 0.001), non-regional lymph nodes (60% vs 96%, P < 0.001) and liver metastases (79% vs 91%, P < 0.001). On multivariable analysis, pN1 status remained significantly associated with lung, bone, and non-regional lymph node (all P < 0.001) metastases, but it was no longer associated with liver metastases (P = 0.3).
Conclusions: pN1 nodal status in M0 patients treated with nephrectomy for renal cell carcinoma is associated with more frequent early metastasis to sites conferring poor prognosis when compared with pN0/x. Our findings highlight the importance of rigorous, early surveillance though the multimodal use of a comprehensive history, physical, laboratory and radiological studies, as outlined in societal guidelines.
(© 2020 The Japanese Urological Association.)

Comment in: Int J Urol. 2020 Jul;27(7):623-624. (PMID: 32452086)
Comment in: Int J Urol. 2020 Jul;27(7):623. (PMID: 32495385)

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Keywords: metastatic disease; node-positive disease; outcomes; recurrence; renal cell carcinoma

Date Created: 20200520 Date Completed: 20210427 Latest Revision: 20210427

20240513

10.1111/iju.14261

32424856