Nodal positivity worsens survival in nonmetastatic renal cell carcinoma

Pathologic nodal positivity (LN+) leads to worse survival outcomes in nonmetastatic renal cell carcinoma (nmRCC) patients after curative nephrectomy, a recent study has found.

Researchers conducted a retrospective assessment of 4,236 nmRCC patients, of whom 1.2 percent (n=52) were LN+ and the rest were not (LN–; 98.8 percent; n=4,184). Main outcomes included overall (OS), cancer-specific (CSS), recurrence-free (RFS), and metastasis-free (MFS) survival rates, compared between patient subgroups.

Over a median follow-up duration of 43.79 months, 410 recurrences were recorded, along with 141 cases of metastasis. A total of 351 patients died, yielding an overall mortality rate of 3.8 percent; of these, 212 were cancer-specific deaths (5.0 percent). All events occurred after curative nephrectomy.

Multivariate analysis was performed to identify predictors of survival outcomes, taking into consideration the participants’ TN* staging. Those with N1 cancers had significantly worse MFS than their N0 comparators (hazard ratio [HR], 6.53, 95 percent confidence interval [CI], 2.3–18.56; p<0.001) across all T grades.

Similarly, RFS (HR, 6.67, 95 percent CI, 4.06–10.94; p<0.001), CSS (HR, 9.34, 95 percent CI, 5.01–17.41; p<0.001), and OS (HR, 5.86, 95 percent CI, 3.41–10.06; p<0.001) were all significantly worse in LN+ vs LN– participants across all T grades.

Notably, when taking into consideration both T and N cancer staging, those with T1N1 or T2N1 malignancies had worse survival outcomes even when compared against T3 or T4 patients with an N0 nodal grade.

“Further prospective studies of nodal positivity should be planned to evaluate the prognostic effects of node positivity in nmRCC,” the researchers said.

*Tumour, Node