Renal cell carcinoma and pathologic nodal disease: Implications for American Joint Committee on Cancer staging

Abstract

Background: Lymph node (LN) metastases are associated with poor outcomes for patients with renal cell carcinoma (RCC). This study compared the survival outcomes of patients with stage III, node-positive disease (pT₁₂₃ N₁ M₀ ) and patients with stage III, node-negative disease (pT₃ N₀ M₀ ).

Methods: A database of 4652 patients with RCC of any histological subtype treated with surgery at The University of Texas MD Anderson Cancer Center from 1993 to 2012 was retrospectively assessed. A total of 115 patients with pT₁₂₃ N₁ M₀ disease, 274 patients with pT₃ N₀ M₀ disease, and 523 patients with pT₁₂₃ N_0/x M₁ disease were included. Overall survival (OS) and cancer-specific survival (CSS) were estimated and compared between each cohort.

Results: Median OS and CSS times were significantly better for pT₃ N₀ M₀ patients than pT₁₂₃ N₁ M₀ patients (OS, 10.2 vs 2.4 years, P < .0001; CSS, not reached vs 2.8 years, P < .0001). Similar median OS and CSS times were noted for pT₁₂₃ N₁ M₀ and pT₁₂₃ N_0/x M₁ patients (OS, 2.4 vs 2.4 years; P = .62; CSS, 2.8 vs 2.4 years; P = .10). In a multivariate analysis, tumor grade (hazard ratio [HR] for OS, 2.47; P < .0001; HR for CSS, 2.99; P < .0001) and pathologic LN involvement (HR for OS, 2.44; P < .0001; HR for CSS, 2.85; P < .0001) were associated with worse OS and CSS.

Conclusions: Among RCC patients classified with stage III disease, those with pT₁₂₃ N₁ M₀ disease had significantly worse survival than those with pT₃ N₀ M₀ disease. OS and CSS were similar for patients with pT₁₂₃ N₁ M₀ disease and patients with pT₁₂₃ N_0/x M₁ disease (stage IV). If validated, these findings suggest that RCC patients with nodal disease should be reclassified as having stage IV disease.

Keywords: kidney cancer; locally advanced renal cell carcinoma; lymph node dissection; nephrectomy; staging.