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Yang DY, Potretzke TA, Miest TS, Bhindi B, Lohse CM, Cheville JC, King BF, Boorjian SA, Leibovich BC, Thompson RH, Potretzke AM. Timing and distribution of early renal cell carcinoma recurrences stratified by pathological nodal status in M0 patients at the time of nephrectomy. Int J Urol 2020; 27:618-622. [PMID: 32424856 DOI: 10.1111/iju.14261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 04/17/2020] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
- David Y Yang
- Departments of, Department of, Urology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Tanner S Miest
- Departments of, Department of, Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bimal Bhindi
- Departments of, Department of, Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - Christine M Lohse
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - John C Cheville
- Department of Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bernard F King
- Department of, Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Stephen A Boorjian
- Departments of, Department of, Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bradley C Leibovich
- Departments of, Department of, Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - R Houston Thompson
- Departments of, Department of, Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron M Potretzke
- Departments of, Department of, Urology, Mayo Clinic, Rochester, Minnesota, USA
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5
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Bazzi WM, Sjoberg DD, Feuerstein MA, Maschino A, Verma S, Bernstein M, O'Brien MF, Jang T, Lowrance W, Motzer RJ, Russo P. Long-term survival rates after resection for locally advanced kidney cancer: Memorial Sloan Kettering Cancer Center 1989 to 2012 experience. J Urol 2014; 193:1911-6. [PMID: 25524244 DOI: 10.1016/j.juro.2014.12.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE We analyzed the 23-year Memorial Sloan Kettering Cancer Center experience with surgical resection, and concurrent adrenalectomy and lymphadenectomy for locally advanced nonmetastatic renal cell carcinoma. MATERIALS AND METHODS We retrospectively reviewed the records of 802 patients who underwent nephrectomy with or without concurrent adrenalectomy or lymphadenectomy for locally advanced renal cell carcinoma, defined as stage T3 or greater and M0. Patients who received adjuvant treatment within 3 months of surgery or had fewer than 3 months of followup or bilateral renal masses at presentation were excluded from analysis. Five and 10-year progression-free and overall survival was estimated by the Kaplan-Meier method. Differences between groups were analyzed by the log rank test. RESULTS A total of 596 (74%) and 206 patients (26%) underwent radical and partial nephrectomy, respectively. Renal cell carcinoma progressed in 189 patients and 104 died of the disease. Median followup in patients without progression was 4.6 years. Symptoms at presentation, ASA(®) classification, tumor stage, histological subtype, grade and lymph node status were significantly associated with progression-free and overall survival. On multivariate analysis adrenalectomy use decreased with time but lymphadenectomy use increased (OR 0.82 vs 1.16 per year). Larger tumors were associated with a higher likelihood of concurrent adrenalectomy and lymphadenectomy. CONCLUSIONS In our series of patients with locally advanced nonmetastatic renal cell carcinoma survival was favorable in those in good health who were asymptomatic at presentation with T3 tumors and negative lymph nodes. Further, there has been a trend toward more selective use of adrenalectomy and increased use of lymphadenectomy.
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Affiliation(s)
- Wassim M Bazzi
- Urology Service, Department of Surgery (WMB, MAF, MB, PR), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Epidemiology and Biostatistics (DDS, AM), Memorial Sloan Kettering Cancer Center, New York, New York; Genitourinary Oncology Service, Division of Solid Tumor Oncology (RJM), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Urology, Cork University Hospital, University College Cork (MFO), Cork, Ireland; Urology Service, Morristown Surgical Associates (TJ), Morristown, New Jersey; Division of Urology, Department of Surgery, University of Utah and Huntsman Cancer Institute (WL), Salt Lake City, Utah
| | - Daniel D Sjoberg
- Urology Service, Department of Surgery (WMB, MAF, MB, PR), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Epidemiology and Biostatistics (DDS, AM), Memorial Sloan Kettering Cancer Center, New York, New York; Genitourinary Oncology Service, Division of Solid Tumor Oncology (RJM), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Urology, Cork University Hospital, University College Cork (MFO), Cork, Ireland; Urology Service, Morristown Surgical Associates (TJ), Morristown, New Jersey; Division of Urology, Department of Surgery, University of Utah and Huntsman Cancer Institute (WL), Salt Lake City, Utah
| | - Michael A Feuerstein
- Urology Service, Department of Surgery (WMB, MAF, MB, PR), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Epidemiology and Biostatistics (DDS, AM), Memorial Sloan Kettering Cancer Center, New York, New York; Genitourinary Oncology Service, Division of Solid Tumor Oncology (RJM), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Urology, Cork University Hospital, University College Cork (MFO), Cork, Ireland; Urology Service, Morristown Surgical Associates (TJ), Morristown, New Jersey; Division of Urology, Department of Surgery, University of Utah and Huntsman Cancer Institute (WL), Salt Lake City, Utah
| | - Alexandra Maschino
- Urology Service, Department of Surgery (WMB, MAF, MB, PR), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Epidemiology and Biostatistics (DDS, AM), Memorial Sloan Kettering Cancer Center, New York, New York; Genitourinary Oncology Service, Division of Solid Tumor Oncology (RJM), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Urology, Cork University Hospital, University College Cork (MFO), Cork, Ireland; Urology Service, Morristown Surgical Associates (TJ), Morristown, New Jersey; Division of Urology, Department of Surgery, University of Utah and Huntsman Cancer Institute (WL), Salt Lake City, Utah
| | - Sweeney Verma
- Urology Service, Department of Surgery (WMB, MAF, MB, PR), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Epidemiology and Biostatistics (DDS, AM), Memorial Sloan Kettering Cancer Center, New York, New York; Genitourinary Oncology Service, Division of Solid Tumor Oncology (RJM), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Urology, Cork University Hospital, University College Cork (MFO), Cork, Ireland; Urology Service, Morristown Surgical Associates (TJ), Morristown, New Jersey; Division of Urology, Department of Surgery, University of Utah and Huntsman Cancer Institute (WL), Salt Lake City, Utah
| | - Melanie Bernstein
- Urology Service, Department of Surgery (WMB, MAF, MB, PR), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Epidemiology and Biostatistics (DDS, AM), Memorial Sloan Kettering Cancer Center, New York, New York; Genitourinary Oncology Service, Division of Solid Tumor Oncology (RJM), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Urology, Cork University Hospital, University College Cork (MFO), Cork, Ireland; Urology Service, Morristown Surgical Associates (TJ), Morristown, New Jersey; Division of Urology, Department of Surgery, University of Utah and Huntsman Cancer Institute (WL), Salt Lake City, Utah
| | - Matthew F O'Brien
- Urology Service, Department of Surgery (WMB, MAF, MB, PR), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Epidemiology and Biostatistics (DDS, AM), Memorial Sloan Kettering Cancer Center, New York, New York; Genitourinary Oncology Service, Division of Solid Tumor Oncology (RJM), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Urology, Cork University Hospital, University College Cork (MFO), Cork, Ireland; Urology Service, Morristown Surgical Associates (TJ), Morristown, New Jersey; Division of Urology, Department of Surgery, University of Utah and Huntsman Cancer Institute (WL), Salt Lake City, Utah
| | - Thomas Jang
- Urology Service, Department of Surgery (WMB, MAF, MB, PR), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Epidemiology and Biostatistics (DDS, AM), Memorial Sloan Kettering Cancer Center, New York, New York; Genitourinary Oncology Service, Division of Solid Tumor Oncology (RJM), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Urology, Cork University Hospital, University College Cork (MFO), Cork, Ireland; Urology Service, Morristown Surgical Associates (TJ), Morristown, New Jersey; Division of Urology, Department of Surgery, University of Utah and Huntsman Cancer Institute (WL), Salt Lake City, Utah
| | - William Lowrance
- Urology Service, Department of Surgery (WMB, MAF, MB, PR), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Epidemiology and Biostatistics (DDS, AM), Memorial Sloan Kettering Cancer Center, New York, New York; Genitourinary Oncology Service, Division of Solid Tumor Oncology (RJM), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Urology, Cork University Hospital, University College Cork (MFO), Cork, Ireland; Urology Service, Morristown Surgical Associates (TJ), Morristown, New Jersey; Division of Urology, Department of Surgery, University of Utah and Huntsman Cancer Institute (WL), Salt Lake City, Utah
| | - Robert J Motzer
- Urology Service, Department of Surgery (WMB, MAF, MB, PR), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Epidemiology and Biostatistics (DDS, AM), Memorial Sloan Kettering Cancer Center, New York, New York; Genitourinary Oncology Service, Division of Solid Tumor Oncology (RJM), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Urology, Cork University Hospital, University College Cork (MFO), Cork, Ireland; Urology Service, Morristown Surgical Associates (TJ), Morristown, New Jersey; Division of Urology, Department of Surgery, University of Utah and Huntsman Cancer Institute (WL), Salt Lake City, Utah
| | - Paul Russo
- Urology Service, Department of Surgery (WMB, MAF, MB, PR), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Epidemiology and Biostatistics (DDS, AM), Memorial Sloan Kettering Cancer Center, New York, New York; Genitourinary Oncology Service, Division of Solid Tumor Oncology (RJM), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Urology, Cork University Hospital, University College Cork (MFO), Cork, Ireland; Urology Service, Morristown Surgical Associates (TJ), Morristown, New Jersey; Division of Urology, Department of Surgery, University of Utah and Huntsman Cancer Institute (WL), Salt Lake City, Utah.
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