Clinical significance of lymph node dissection in renal cell carcinoma.
SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY(2009)
Abstract
Objective. To identify the role of lymph node dissection in renal cell carcinoma (RCC). Material and methods. A total of 100 patients (66 males, 34 females) were enrolled in the study. The mean age and tumor size were 61.4 years and 5.8 cm, respectively. A total of 41 patients (41%) had tumors < 4 cm in diameter. The pathological status was pT1, pT2 and pT3 in 60, 11 and 29 patients, respectively. Results. In total, lymph node metastases were found in seven cases (7%). Of 40 patients with pT1a tumors (tumor size < 4 cm), one (2.5%) had lymph node metastasis. Patients with lymph node metastases had significantly larger tumors than those without (8.9 vs 5.5 cm; p < 0.05). Regarding patient outcome, 33 (33%) had tumor progression (alive with disease, n = 14; disease-specific death, n = 19) after a median follow-up period of 54.0 months. In univariate analysis, 15/18 prognostic markers [tumor size, tumor grade, pT, pN and M categories, stage, microscopic venous invasion (V category), microscopic lymphatic invasion (Ly category), pathological tumor infiltration pattern (INF category), plasma fibrinogen, C-reactive protein, immunosuppressive acidic protein, alpha-2 globulin and erythrocyte sedimentation rates at 1 and 2 h] were common significant predictors of tumor progression. A Cox hazard model revealed tumor size, tumor grade and pathological stage to be independent prognostic factors. Conclusions. Tumor size is a crucial prognostic factor for tumor progression, and lymph node dissection may be omitted in T1a tumors.
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Key words
lymph node dissection,metastasis,prognosis,renal cell carcinoma
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