Survival benefit with extended lymphadenectomy for advanced renal malignancy: A population-based analysis

doi:10.1016/j.ajur.2019.06.004

Asian Journal of Urology, 2020, 7 (1): 29-36 doi: 10.1016/j.ajur.2019.06.004

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Survival benefit with extended lymphadenectomy for advanced renal malignancy: A population-based analysis

Dean Laganosky^a,*(

),Christopher P. Filson^a,b,c,Dattatraya Patil^a,Viraj A. Master^a,b

^a Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
^b Winship Cancer Institute, Atlanta, GA, USA

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Abstract

Objective: We used population-based data to examine the possible benefit of extended lymphadenectomy for patients with renal malignancy in the setting of more advanced disease. Methods: The Surveillance, Epidemiology, and End Results (SEER) database was utilized to identify non-metastatic, T3-T4 renal cancer patients from 2004-2015 treated with removal of ≥1 lymph node at the time of nephrectomy. Non-parametric bivariate statistics were used to assess associations between covariates of interest and extended lymphadenectomy (≥10 lymph nodes removed). Cancer-specific survival (CSS) and overall survival (OS) benefit was evaluated using Kaplan-Meier analysis. Results: Of the 4397 patients identified, 816 (18.6%) underwent extended lymphadenectomy. For patients with T3a disease, 5-year CSS and OS benefit with extended lymphadenectomy did not reach statistical significance (CSS: hazard ratio [HR] 0.98, 95% confidence interval [CI] 0.77-1.24; OS: HR 0.96, 95% CI 0.77-1.20). Conversely, for those with T3b-T3c disease, extended lymphadenectomy led to statistically significant improvements in both 5-year CSS and OS compared to non-extended lymphadenectomy (CSS: HR 0.78, 95% CI 0.61-0.99; OS: HR 0.72, 95% CI 0.58-0.90). Finally, for those with T4 disease, use of extended lymphadenectomy had OS benefit after 5 years (OS: HR 0.51, HR 0.29-0.90, p = 0.02). Conclusion: Based on population-level data, extended lymphadenectomy was associated with improved survival in select patients with advanced renal malignancy treated with surgical nephrectomy. Understanding the basis of these real-world findings in the face of conflicting randomized trial results will be key, moving forward.

Key words： Extended lymphadenectomy Lymph node dissection Advanced renal malignancy Renal cell carcinoma

Received: 14 June 2018 Available online: 29 June 2019

Corresponding Authors: Dean Laganosky E-mail: Dean.Laganosky@emory.edu

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Dean Laganosky,Christopher P. Filson,Dattatraya Patil, et al. Survival benefit with extended lymphadenectomy for advanced renal malignancy: A population-based analysis[J]. Asian Journal of Urology, 2020, 7(1): 29-36.

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http://www.ajurology.com/EN/10.1016/j.ajur.2019.06.004 OR http://www.ajurology.com/EN/Y2020/V7/I1/29

Cohort generation. Lymphadenectomy cohort generation using Surveillance, Epidemiology, and End Results data through application of select exclusion criteria is shown. Extended lymphadenectomy patients were further selected from this lymphadenectomy cohort based on the patient's receipt of 10 or more lymph nodes removed at the time of surgery.

Characteristics of cohort based on performance of extended lymphadenectomy.

Overall survival for kidney cancer patients with and without extended lymphadenectomy. Kaplan-Meier analysis showing overall survival data for patients with and without receipt of extended lymphadenectomy by tumor stage (Figure 2A: T3a disease; Figure 2B: T3b/T3c disease; Figure 2C: T4 disease). The Y-axis shows overall survival probability. The X-axis shows time (in months) from receipt of surgery with lymphadenectomy or extended lymphadenectomy. The dashed graph line represents patients who underwent extended lymphadenectomy in each analysis. The solid graph line represents patients who underwent non-extended lymphadenectomy in each analysis. Statistically significant overall survival benefit was demonstrated for those undergoing extended lymphadenectomy in the setting of T3b/T3c and T4 disease (Figure 2B and 2C), but not T3a disease (Figure 2A) compared to performance of less extensive lymphadenectomy.

Cancer-specific and overall survival from extended lymphadenectomy.

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