To Be or “Node” to Be: Nodal Disease and the Role of Lymphadenectomy in the Treatment of Renal Cell Carcinoma

Abstract

Lymph node involvement in renal cell carcinoma (RCC) correlates with poor oncologic outcomes. However, current RCC staging guidelines may not fully reflect the survival impact of lymph node positive disease. Recent data demonstrates that nodal disease has significant impact on survival and modifications to current staging guidelines have been proposed. Lymph node dissection (LND) at the time of surgical intervention for RCC remains controversial. While clinical trial data have demonstrated conflicting evidence for LND, some institutional studies suggests that carefully selected patients at high-risk for recurrence may benefit from LND. Prospectively, clinical trials are examining treating nodal disease and disease at high-risk of recurrence in the neoadjuvant and/or adjuvant setting at the time of nephrectomy. These promising trials are poised, if successful, to influence the treatment paradigm for localized RCC.

A challenging frontier – the genomics and therapeutics of nonclear cell renal cell carcinoma

“…One notable addition to the list of ongoing clinical trials is the PROSPER RCC trial; in this study, patients with biopsy-proven RCC of any histology who have locally advanced or oligometastatic disease that can be completely resected via nephrectomy receive perioperative nivolumab versus nephrectomy alone [64,65]. This study is the firstof-its-kind by including any RCC histology and incorporating a checkpoint inhibitor earlier in the treatment course.…”

Predictors of Recurrence for T3a RCC: A Recurring Conundrum

“…Although the gold standard treatment for localized renal cell carcinoma (RCC) is radical nephrectomy (RN) or partial nephrectomy (PN), recurrence rates remain high at 7%, 26%, and 39% for T1, T2, and T3 staged disease, respectively [ 1 ]. Thus, having a high-fidelity staging system that accurately assesses the risk of recurrence and identifies patients who may benefit from adjuvant therapy and close monitoring is critical to improving oncologic outcomes [ 2 , 3 , 4 , 5 ].…”