Assessing lymph node status in patients with kidney cancer

Abstract

Accurate detection of lymph node involvement on pre-operative imaging in patients diagnosed with renal cell carcinoma (RCC) is critical for determination of disease stage, one of the most significant prognostic factors in RCC. The presence of lymph node involvement in RCC doubles a patient’s risk of distant metastasis and significantly reduces their 5-year survival. Currently, lymph node involvement in patients with RCC is evaluated with numerous modalities, with rapid advancements occurring across these modalities. The purpose of this study was to evaluate the advantages and disadvantages of each modality and utilize sensitivities and specificities to determine the highest performing modalities for accurate lymph node involvement in renal cancer. A comprehensive computer-based literature search of full-length original research English language studies of human subjects with biopsy-proven RCC was performed to evaluate publications on the diagnostic performance of color Doppler sonography (CDS), magnetic resonance imaging (MRI), lymphotrophic nanoparticle enhanced MRI (LNMRI), multidetector-row computed tomography (MDCT), F-fluoro-2-deoxyglucose positron emission tomography (FDG-PET), and PET/CT for evaluation of lymph node status in kidney cancers in articles that were published prior to May 2018. Limited studies were available for evaluating CDS performance for determination of lymph node involvement in renal cancer. While CT is the most common modality for nodal staging, due to its availability and relatively low expense, it did not demonstrate the highest performance of the modalities examined for determination of lymph node status in patients with RCC. Of the modalities examined, MRI demonstrated the highest sensitivity (92–95.7%) for detection of lymph node involvement in RCC. Studies of lymph node involvement in RCC using both MRI and CT indicated that using the current diameter criteria (greater than 1 cm) for determination of positive lymph nodes should be re-evaluated as micro-metastases are frequently overlooked. Studies evaluating lymph node involvement with FDG-PET had the highest specificity (100%), indicating FDG-PET is the preferred modality for confirming lymph node involvement and extent of involvement. However, due to the low sensitivity of FDG-PET, clinicians should be skeptical of negative reports of lymph node involvement in RCC patients. Further studies examining determination of lymph node involvement in renal cancer across modalities are greatly needed, current literature suggests utilizing a combination of MRI and FDG-PET may offer the highest accuracy.

A population-based study to predict distant metastasis in patients with renal cell carcinoma

“…Additionally, the influence of regional lymph node involvement on the distant metastatic potential of RCC was also demonstrated in our finding. Another study found that regional lymph node involvement increased the occurrence of distant metastasis by 50% (44). Our nomogram highlighted the fact that the rate of distant metastasis increased with the RCC differentiation (from well to poorly differentiated).…”

Patterns of distant metastases in patients with clear cell renal cell carcinoma––A population‐based analysis

“…In addition, we found that the proportion of all metastatic patterns showed stable trends with no obvious changes in recent years. However, the metastatic rate in this study was significantly lower than 18%–30% reported in previous studies 6,7 . We attributed this to the fact that we only included patients with distant organs metastases, while regional (did not meet the inclusion criteria) and distant (due to the limitation of the database itself) lymph node metastases (LNM) were excluded.…”

“…However, the metastatic rate in this study was significantly lower than 18%-30% reported in previous studies. 6,7 We attributed this to the fact that we only included patients with distant organs metastases, while regional (did not meet the inclusion criteria) and distant (due to the limitation of the database itself) lymph node metastases (LNM) were excluded. Moreover, only ccRCC was included in this study, while some other pathological types had high potential for malignant metastasis, such as Bellini duct carcinoma and medullary carcinoma.…”

“…4,5 Previous studies have reported that up to 18%-30% of RCC patients were with systemic metastases at the time of initial diagnosis, and another third progressed to metastatic diseases after nephrectomy during the long-term follow-up. 6,7 Generally, patients with advanced or metastatic RCC (mRCC) have poor prognosis, with a median overall survival (OS) of about 13 months. 8 Recently, the 5-year OS increased slightly from 7.3% to 12.3%.…”

Multiomic Analysis of Cereblon Expression and Its Prognostic Value in Kidney Renal Clear Cell Carcinoma, Lung Adenocarcinoma, and Skin Cutaneous Melanoma

“…A longer TNM stage progression results in a lower 5-year survival rate in patients diagnosed with renal cell carcinoma [ 36 ]. CRBN expression in nodal metastasis level N1 (i.e., metastasis in one to three axillary lymph nodes) was lower than in N0 (i.e., no regional lymph node metastasis), as illustrated in Figure 3 g [ 37 ]. Based on the KIRC subtype, the ccA subtype overexpresses a set of genes involved in hypoxia, angiogenesis, fatty acid metabolism, and organic acid metabolism, whereas the ccB subtype overexpresses genes involved in cell differentiation, epithelial to mesenchymal transition (EMT), cell cycle, and transforming growth factor beta (TGFβ), resulting in a more aggressive cancer progression [ 38 ].…”