Node-positive renal cell carcinoma in the absence of distant metastases: predictors of cancer-specific mortality in a population-based cohort

Study Type – Prognosis (cohort series) Level of Evidence 2a What's known on the subject? and What does the study add? Nodal metastases, even in the absence of distant metastases, portend a bad prognosis. The percentage of positive nodes (PPN) represents an important predictor of cancer-specific mortality (CSM) in patients in the group TanyN1M0. In consequence, universal inclusion of PPN should be considered in prospective and retrospective CSM analyses. OBJECTIVES • To examine the outcomes of patients with node-positive renal cell carcinoma (RCC) in the absence of distant metastases in a large population-based cohort of patients • To examine the ability of standard risk factors to predict cancer-specific mortality (CSM). PATIENTS AND METHODS • Using the Surveillance, Epidemiology, and End Results database, a total of 799 patients with RCC nodal metastases and absence of distant metastases undergoing nephrectomy were identified. • Univariable and multivariable analyses was performed with the aim of identifying independent predictors of CSM in this cohort of patients. • Specifically, we examined the effect of the number of removed nodes (NRN), the number of positive nodes (NPN) and the percentage of positive nodes (PPN) on CSM. RESULTS • Actuarial survival estimates showed that 53.2, 37.8 and 25.7% of patients survived at 24, 60 and 120 months after nephrectomy. • In Kaplan–Meier analyses, NRN failed to clearly discriminate between recorded CSM rates (log rank P= 0.07). • Discrimination was noted when CSM was stratified according to NPN (log rank P= 0.02) and PPN (log rank P= 0.001). • In multivariable analyses, age, Fuhrman grade, histological subtype, T stage and PPN were independent predictors of CSM. CONCLUSIONS • Our data indicate that CSM of patients with exclusive nodal metastases differs according to PPN. • Consequently, PPN warrants consideration in future prognostic schemes.