Prognostic Significance of Pathologic Lymph Node Invasion in Metastatic Renal Cell Carcinoma in the Immunotherapy Era
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Prognostic Significance of Pathologic Lymph Node Invasion in Metastatic Renal Cell Carcinoma in the Immunotherapy Era. / Scheipner, Lukas; Barletta, Francesco; Cano Garcia, Cristina; Incesu, Reha-Baris; Morra, Simone; Baudo, Andrea; Assad, Anis; Tian, Zhe; Saad, Fred; Shariat, Shahrokh F; Briganti, Alberto; Chun, Felix K H; Tilki, Derya; Longo, Nicola; Carmignani, Luca; Pichler, Martin; Ahyai, Sascha; Karakiewicz, Pierre I.
in: ANN SURG ONCOL, Jahrgang 30, Nr. 13, 12.2023, S. 8780-8785.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Prognostic Significance of Pathologic Lymph Node Invasion in Metastatic Renal Cell Carcinoma in the Immunotherapy Era
AU - Scheipner, Lukas
AU - Barletta, Francesco
AU - Cano Garcia, Cristina
AU - Incesu, Reha-Baris
AU - Morra, Simone
AU - Baudo, Andrea
AU - Assad, Anis
AU - Tian, Zhe
AU - Saad, Fred
AU - Shariat, Shahrokh F
AU - Briganti, Alberto
AU - Chun, Felix K H
AU - Tilki, Derya
AU - Longo, Nicola
AU - Carmignani, Luca
AU - Pichler, Martin
AU - Ahyai, Sascha
AU - Karakiewicz, Pierre I
N1 - © 2023. The Author(s).
PY - 2023/12
Y1 - 2023/12
N2 - BACKGROUND: This study aimed to test the prognostic significance of pathologically confirmed lymph node invasion in metastatic renal cell carcinoma (mRCC) patients in this immunotherapy era.METHODS: Surgically treated mRCC patients were identified in the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2018. Kaplan-Meier plots and multivariable Cox-regression models were fitted to test for differences in cancer-specific mortality (CSM) and overall mortality (OM) according to N stage (pN0 vs pN1 vs. pNx). Subgroup analyses addressing pN1 patients tested for CSM and OM differences according to postoperative systemic therapy status.RESULTS: Overall, 3149 surgically treated mRCC patients were identified. Of these patients, 443 (14%) were labeled as pN1, 812 (26%) as pN0, and 1894 (60%) as pNx. In Kaplan-Meier analyses, the median CSM-free survival was 15 months for pN1 versus 40 months for pN0 versus 35 months for pNx (P < 0.001). In multivariable Cox regression analyses, pN1 independently predicted higher CSM (hazard ratio [HR], 1.88; P < 0.01) and OM (HR, 1.95; P < 0.01) relative to pN0. In sensitivity analyses addressing pN1 patients, postoperative systemic therapy use independently predicted lower CSM (HR, 0.73; P < 0.01) and OM (HR, 0.71; P < 0.01).CONCLUSION: Pathologically confirmed lymph node invasion independently predicted higher CSM and OM for surgically treated mRCC patients. For pN1 mRCC patients, use of postoperative systemic therapy was associated with lower CSM and OM. Consequently, N stage should be considered for individual patient counseling and clinical decision-making. Consort diagram of the study population.
AB - BACKGROUND: This study aimed to test the prognostic significance of pathologically confirmed lymph node invasion in metastatic renal cell carcinoma (mRCC) patients in this immunotherapy era.METHODS: Surgically treated mRCC patients were identified in the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2018. Kaplan-Meier plots and multivariable Cox-regression models were fitted to test for differences in cancer-specific mortality (CSM) and overall mortality (OM) according to N stage (pN0 vs pN1 vs. pNx). Subgroup analyses addressing pN1 patients tested for CSM and OM differences according to postoperative systemic therapy status.RESULTS: Overall, 3149 surgically treated mRCC patients were identified. Of these patients, 443 (14%) were labeled as pN1, 812 (26%) as pN0, and 1894 (60%) as pNx. In Kaplan-Meier analyses, the median CSM-free survival was 15 months for pN1 versus 40 months for pN0 versus 35 months for pNx (P < 0.001). In multivariable Cox regression analyses, pN1 independently predicted higher CSM (hazard ratio [HR], 1.88; P < 0.01) and OM (HR, 1.95; P < 0.01) relative to pN0. In sensitivity analyses addressing pN1 patients, postoperative systemic therapy use independently predicted lower CSM (HR, 0.73; P < 0.01) and OM (HR, 0.71; P < 0.01).CONCLUSION: Pathologically confirmed lymph node invasion independently predicted higher CSM and OM for surgically treated mRCC patients. For pN1 mRCC patients, use of postoperative systemic therapy was associated with lower CSM and OM. Consequently, N stage should be considered for individual patient counseling and clinical decision-making. Consort diagram of the study population.
KW - Humans
KW - Carcinoma, Renal Cell/surgery
KW - Prognosis
KW - Kidney Neoplasms/surgery
KW - Lymph Nodes/pathology
KW - Lymph Node Excision
KW - Immunotherapy
U2 - 10.1245/s10434-023-14367-6
DO - 10.1245/s10434-023-14367-6
M3 - SCORING: Journal article
C2 - 37815682
VL - 30
SP - 8780
EP - 8785
JO - ANN SURG ONCOL
JF - ANN SURG ONCOL
SN - 1068-9265
IS - 13
ER -
