Radical Nephrectomy with and without Lymph-Node Dissection: Final Results of European Organization for Research and Treatment of Cancer (EORTC) Randomized Phase 3 Trial 30881

Blom, J.; Poppel, Hendrik Van; Maréchal, Jean Marie; Jacqmin, Didier; Schröder, Fritz H.; Prijck, Linda de; Sylvester, Richard

doi:10.1016/j.eururo.2008.09.052

Cited by 382 publications

(226 citation statements)

References 23 publications

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“…Unfortunately, to the best of our knowledge, randomized data supporting the survival benefit of lymphadenectomy in MRCC patients do not exist. 18 In addition to the main findings related to the importance of lymph node stage in patients with MRCC, we also observed that year of surgery and race affect cancerspecific mortality in patients treated with cytoreductive nephrectomy and lymphadenectomy. More favorable cancer-specific mortality rates were recorded in more recent years.…”

supporting

confidence: 55%

Prognostic significance of lymph node invasion in patients with metastatic renal cell carcinoma

Lughezzani

Capitanio

Jeldres

et al. 2009

Cancer

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BACKGROUND: Virtually all staging schemes aimed at predicting the prognosis of surgically treated patients diagnosed with metastatic renal cell carcinoma (MRCC) omit the use of lymph node stage. In the current study, the authors tested the prognostic significance of lymph node stage in patients with MRCC within a population‐based cohort of patients treated with cytoreductive nephrectomy to assess whether the inclusion of lymph node stage could improve the accuracy of cancer‐specific mortality predictions. METHODS: Within the Surveillance, Epidemiology, and End Results database, the authors identified 1153 patients who were treated with cytoreductive nephrectomy for MRCC, with (negative lymph nodes [N0] vs positive lymph nodes [N1‐2]) or without (unknown lymph node stage [Nx]) lymphadenectomy. Of 797 patients treated with lymphadenectomy, 42.9% were found to have lymph node metastases. Kaplan‐Meier plots and univariate and multivariate Cox regression analyses tested the statistical significance and the independent predictor status of lymph node stage, Fuhrman grade, tumor size, year of surgery, race, sex, and age in patients who underwent lymphadenectomy at the time of cytoreductive nephrectomy. RESULTS: At 3 years after cytoreductive nephrectomy, the cancer‐specific mortality‐free rates of N1‐2 versus N0 versus Nx patients were 14.4% versus 34.7% versus 34.0%, respectively. Lymph node stage represented the most informative variable and achieved independent predictor status in all multivariate models (P < .001). Consideration of lymph node stage added 3.2% accuracy to other predictors of cancer‐specific mortality. CONCLUSIONS: The findings of the current study indicate that lymph node stage should be considered in prognostic models. The TNM staging of MRCC patients also should rely on the stage of locoregional lymph nodes, because the 3‐year cancer‐specific mortality rates of lymph node‐negative and lymph node‐positive MRCC patients differ by as much as 20%. Cancer 2009. © 2009 American Cancer Society.

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supporting

confidence: 55%

Prognostic significance of lymph node invasion in patients with metastatic renal cell carcinoma

Lughezzani

Capitanio

Jeldres

et al. 2009

Cancer

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“…There were no local recurrences, but the study was small with a short follow-up (especially in the portless group: mean = 7.1 months; range 2.7-17.3) (plot 7.1, full report [13] [8] was a European-wide multi-centre RCT (n=772) comparing radical nephrectomy with or without complete lymph node dissection. The subgroup analysis of the cT1 and cT2 population from this trial [8] showed no evidence of a difference between the groups (HR 1.096 (0.81, 1.47); log rank p = 0.55). However, the lymphadenectomy in this trial was not standardised.…”

Section: 22f Single Port Laparoscopic Radical Nephrectomy Vs Lamentioning

confidence: 99%

“…Open radical nephrectomy was the standard curative intervention for localised RCC for the past five decades [2]. Furthermore, there were controversies over whether radical nephrectomy should be performed in conjunction with ipsilateral adrenalectomy as originally described by Robson, or if the adrenal should be preserved [3][4][5][6] and whether ipsilateral extended retroperitoneal lymphadenectomy or limited hilar lymphadenectomy should be performed [7,8].…”

Section: Introductionmentioning

confidence: 99%

Systematic Review of Oncological Outcomes Following Surgical Management of Localised Renal Cancer

MacLennan

Imamura

Lapitan³

et al. 2012

European Urology

304

174

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Context: Renal cell carcinoma (RCC) accounts for 2-3% of adult malignancies. There remain uncertainties over the oncological outcomes for the surgical management of localised RCC. Objective: To systematically review relevant literature comparing oncological outcomes of surgical management of localised RCC (T1-2N0M0). Evidence Acquisition: Relevant databases including MEDLINE, Embase and the Cochrane Library were searched up to October 2010, and an updated scoping search was performed up to January 2012. Randomised or quasi-randomised controlled trials (RCTs), prospective observational studies with controls, retrospective matched-pair studies, and comparative studies from well defined registries/databases were included. The main outcomes were overall survival, cancer-specific survival, recurrence and metastases. The Cochrane risk of bias (RoB) tool was used to assess RCTs and an extended version was used to assess Non Randomised Studies (NRS). The quality of evidence was assessed using GRADE. Evidence Synthesis: 4580 abstracts and 389 full text articles were assessed. 34 studies met the inclusion criteria (6 RCTs and 28 NRSs). Meta-analyses were planned but were deemed inappropriate due to data heterogeneity. There were high risks of bias and low quality evidence across the evidence base. Open radical nephrectomy and open partial nephrectomy showed similar cancer-specific and overall survival, but when both open and laparoscopic approaches are considered together the evidence showed improved survival for partial nephrectomy for tumours ≤4cm.Overall, the evidence suggests either equivalent or better survival with partial nephrectomy. Laparoscopic radical nephrectomy offered equivalent survival to open radical nephrectomy, and all laparoscopic approaches achieved equivalent survival. Open and laparoscopic partial nephrectomy achieved equivalent survival. The issue of ipsilateral adrenalectomy or complete lymph node dissection with radical nephrectomy or partial nephrectomy remains unresolved. Conclusions: The evidence base suggests localised RCC are best managed by nephron sparing surgery where technically feasible. However, the current evidence base has significant limitations due to studies of low methodological quality marked by high risks of bias.

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“…1 Furthermore, randomized prospective data showed no benefit in terms of survival when carrying out lymphadenectomy (LND) in patients with clinical T1-3 N0 M0 RCC tumors. 2 As a consequence of those and other possible reasons, a progressive decline in the use of LND has been observed in the past years, especially in the USA.…”

Section: Editorial Comment To Nodal Involvement At Nephrectomy Is Assmentioning

confidence: 99%

Editorial Comment to Nodal involvement at nephrectomy is associated with worse survival: A stage‐for‐stage and grade‐for‐grade analysis

Capitanio¹,

Briganti²

2012

Int J of Urology

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Radical Nephrectomy with and without Lymph-Node Dissection: Final Results of European Organization for Research and Treatment of Cancer (EORTC) Randomized Phase 3 Trial 30881

Cited by 382 publications

References 23 publications

Prognostic significance of lymph node invasion in patients with metastatic renal cell carcinoma

Prognostic significance of lymph node invasion in patients with metastatic renal cell carcinoma

Systematic Review of Oncological Outcomes Following Surgical Management of Localised Renal Cancer

Editorial Comment to Nodal involvement at nephrectomy is associated with worse survival: A stage‐for‐stage and grade‐for‐grade analysis

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