Temporal trends and utilization rates of lymph node dissection in patients with renal cell carcinoma: implications for adjuvant therapies

You have accessJournal of UrologyCME1 Apr 2023PD43-10 TEMPORAL TRENDS AND UTILIZATION RATES OF LYMPH NODE DISSECTION IN PATIENTS WITH RENAL CELL CARCINOMA: IMPLICATIONS FOR ADJUVANT THERAPIES Giacomo Musso, Giuseppe Rosiello, Giuseppe Fallara, Chiara Re, Francesco Cei, Giuseppe Basile, Daniele Cignoli, Daniela Canibus, Francesco De Cobelli, Giorgio Brembilla, Roberta Lucianò, Nazario Tenace, Rayan Matloob, Roberto Bertini, Alberto Briganti, Francesco Montorsi, Andrea Salonia, Alessandro Larcher, and Umberto Capitanio Giacomo MussoGiacomo Musso More articles by this author , Giuseppe RosielloGiuseppe Rosiello More articles by this author , Giuseppe FallaraGiuseppe Fallara More articles by this author , Chiara ReChiara Re More articles by this author , Francesco CeiFrancesco Cei More articles by this author , Giuseppe BasileGiuseppe Basile More articles by this author , Daniele CignoliDaniele Cignoli More articles by this author , Daniela CanibusDaniela Canibus More articles by this author , Francesco De CobelliFrancesco De Cobelli More articles by this author , Giorgio BrembillaGiorgio Brembilla More articles by this author , Roberta LucianòRoberta Lucianò More articles by this author , Nazario TenaceNazario Tenace More articles by this author , Rayan MatloobRayan Matloob More articles by this author , Roberto BertiniRoberto Bertini More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , Alessandro LarcherAlessandro Larcher More articles by this author , and Umberto CapitanioUmberto Capitanio More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003353.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The role of lymph node dissection (LND) in renal cell carcinoma (RCC) patients is still controversial. Despite several studies showed no survival benefits of LND in RCC, performing LND may be still important for staging purposes, in the light of new promising adjuvant treatments in locally advanced disease. Thus, we aimed at assessing the trend of LND over the last 30 years. METHODS: We relied on a prospectively maintained database including 2,880 patients treated with radical (RN) or partial nephrectomy (PN) for non-metastatic RCC at a high-volume centre between 1990 and 2021. High-risk disease was defined as patients harbouring pT3-4, and/or pN1 and/or Fuhrman grade 3-4 RCC. Temporal trend analyses using estimated annual percentages changes (EAPC) were performed. Multivariable logistic regression analyses (MVA) tested the effect of year of surgery on LND, after adjusting for age at surgery, clinical tumor size, clinical tumor stage, clinical nodal stage, type of surgery and surgical approach. RESULTS: Overall, 2,880 patients underwent either PN or RN for RCC. Of these, 1,135 (39%) underwent LND, but only 161 (5.6%) showed confirmed pN invasion. Patients treated with LND were younger (61 vs. 63 yrs; p<0.001), more frequently symptomatic (51 vs. 24%; p<0.001), with higher clinical size (7 vs. 3.8 cm; p<0.001) and higher rates of suspicious cN+ disease (25 vs. 6.8%; p<0.001). Time trends analyses revealed a reduction in LND over time, both in the overall population (from 74 to 33%; EAPC: -3.7%; p<0.001) and in high-risk patients (from 72 to 50%; EAPC: -1.4%; p<0.001). Moreover, the median number of LNs removed also decreased over time, from 6 [Interquartile range (IQR): 3-5] to 2 (IQR: 1-4; p<0.001). At MVA, patients undergoing surgery for RCC in the most recent years were less likely to receive LND (OR: 0.96; 95%CI 0.95-0.98; p<0.001). CONCLUSIONS: Over the last 30 years, the rates of LND performed in RCC patients significantly decreased over time. Such trend was also shown in high-risk patients, regardless of tumor characteristics or surgical approach. Given the importance of LND for staging purposes, the observed phenomenon may increase the proportion of patients with unknown locally advanced disease at time of surgery and their inclusion in protocols for adjuvant therapies. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1122 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giacomo Musso More articles by this author Giuseppe Rosiello More articles by this author Giuseppe Fallara More articles by this author Chiara Re More articles by this author Francesco Cei More articles by this author Giuseppe Basile More articles by this author Daniele Cignoli More articles by this author Daniela Canibus More articles by this author Francesco De Cobelli More articles by this author Giorgio Brembilla More articles by this author Roberta Lucianò More articles by this author Nazario Tenace More articles by this author Rayan Matloob More articles by this author Roberto Bertini More articles by this author Alberto Briganti More articles by this author Francesco Montorsi More articles by this author Andrea Salonia More articles by this author Alessandro Larcher More articles by this author Umberto Capitanio More articles by this author Expand All Advertisement PDF downloadLoading ...