Lymphadenopathies in patients with renal cell carcinoma

clinical and pathological predictors of pathologically confirmed lymph node invasion

Umberto Capitanio, Federico Deho’, Paolo Dell’Oglio, Alessandro Larcher, Paolo Capogrosso, Alessandro Nini, Cristina Carenzi, Massimo Freschi, Alberto Briganti, Andrea Salonia, Francesco Montorsi, Roberto Bertini

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Introduction: In renal cell carcinoma (RCC), lymph node status at preoperative imaging is affected by a non-negligible false-positive rate. We aimed to investigate which factors are related to a concordance between clinical suspicion and pathological confirmation of lymph node invasion (LNI). Methods: At a single tertiary care institution, 2954 RCC patients underwent either partial or radical nephrectomy. For the aim of the study, only clinically positive lymph node cases were included (cN1). Statistical analyses assessed the concordance between preoperative and pathological nodal status. Results: Preoperative axial CT scans revealed 424 (14.4 %) patients showing at least one enlarged lymph node suspected for LNI (cN1). All lymphadenopathies were removed at surgery, and LNI was pathologically confirmed (pN1) in 122 patients (28.8 %). When focusing the analyses on clinical characteristics (variables known before surgery), metastases at diagnosis [OR 3.0 (95 %1.9–4.8), p <0.001] and tumor size [OR 1.1 (95 % 1.1–1.2), p <0.001] were the two most informative predictors of concordance between clinical and pathological nodal status. Concordance was also more likely in patients with papillary type II tumors (55.6 %) relative to papillary type I (38.1 %), clear cell (27.7 %) and chromophobe (8.3 %) tumors. At multivariable analyses, none of the considered blood markers resulted to be independently associated with LNI. Conclusions: Roughly 70 % of patients showing a suspected lymph node preoperatively do not show LNI at the final pathological report. Among patients with clinically positive nodes, clinical tumor size and metastases at diagnosis represent the most informative and independent predictors of confirmed LNI at final pathology.

Original languageEnglish
Pages (from-to)1-7
Number of pages7
JournalWorld Journal of Urology
DOIs
Publication statusAccepted/In press - Dec 15 2015

Fingerprint

Renal Cell Carcinoma
Lymph Nodes
Neoplasms
Lymphadenopathy
Neoplasm Metastasis
Tertiary Healthcare
Nephrectomy
Pathology

Keywords

  • Lymph node dissection
  • Lymph node invasion
  • Lymphadenectomy
  • Renal cell carcinoma

ASJC Scopus subject areas

  • Urology

Cite this

Lymphadenopathies in patients with renal cell carcinoma : clinical and pathological predictors of pathologically confirmed lymph node invasion. / Capitanio, Umberto; Deho’, Federico; Dell’Oglio, Paolo; Larcher, Alessandro; Capogrosso, Paolo; Nini, Alessandro; Carenzi, Cristina; Freschi, Massimo; Briganti, Alberto; Salonia, Andrea; Montorsi, Francesco; Bertini, Roberto.

In: World Journal of Urology, 15.12.2015, p. 1-7.

Research output: Contribution to journalArticle

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title = "Lymphadenopathies in patients with renal cell carcinoma: clinical and pathological predictors of pathologically confirmed lymph node invasion",
abstract = "Introduction: In renal cell carcinoma (RCC), lymph node status at preoperative imaging is affected by a non-negligible false-positive rate. We aimed to investigate which factors are related to a concordance between clinical suspicion and pathological confirmation of lymph node invasion (LNI). Methods: At a single tertiary care institution, 2954 RCC patients underwent either partial or radical nephrectomy. For the aim of the study, only clinically positive lymph node cases were included (cN1). Statistical analyses assessed the concordance between preoperative and pathological nodal status. Results: Preoperative axial CT scans revealed 424 (14.4 {\%}) patients showing at least one enlarged lymph node suspected for LNI (cN1). All lymphadenopathies were removed at surgery, and LNI was pathologically confirmed (pN1) in 122 patients (28.8 {\%}). When focusing the analyses on clinical characteristics (variables known before surgery), metastases at diagnosis [OR 3.0 (95 {\%}1.9–4.8), p <0.001] and tumor size [OR 1.1 (95 {\%} 1.1–1.2), p <0.001] were the two most informative predictors of concordance between clinical and pathological nodal status. Concordance was also more likely in patients with papillary type II tumors (55.6 {\%}) relative to papillary type I (38.1 {\%}), clear cell (27.7 {\%}) and chromophobe (8.3 {\%}) tumors. At multivariable analyses, none of the considered blood markers resulted to be independently associated with LNI. Conclusions: Roughly 70 {\%} of patients showing a suspected lymph node preoperatively do not show LNI at the final pathological report. Among patients with clinically positive nodes, clinical tumor size and metastases at diagnosis represent the most informative and independent predictors of confirmed LNI at final pathology.",
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T1 - Lymphadenopathies in patients with renal cell carcinoma

T2 - clinical and pathological predictors of pathologically confirmed lymph node invasion

AU - Capitanio, Umberto

AU - Deho’, Federico

AU - Dell’Oglio, Paolo

AU - Larcher, Alessandro

AU - Capogrosso, Paolo

AU - Nini, Alessandro

AU - Carenzi, Cristina

AU - Freschi, Massimo

AU - Briganti, Alberto

AU - Salonia, Andrea

AU - Montorsi, Francesco

AU - Bertini, Roberto

PY - 2015/12/15

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N2 - Introduction: In renal cell carcinoma (RCC), lymph node status at preoperative imaging is affected by a non-negligible false-positive rate. We aimed to investigate which factors are related to a concordance between clinical suspicion and pathological confirmation of lymph node invasion (LNI). Methods: At a single tertiary care institution, 2954 RCC patients underwent either partial or radical nephrectomy. For the aim of the study, only clinically positive lymph node cases were included (cN1). Statistical analyses assessed the concordance between preoperative and pathological nodal status. Results: Preoperative axial CT scans revealed 424 (14.4 %) patients showing at least one enlarged lymph node suspected for LNI (cN1). All lymphadenopathies were removed at surgery, and LNI was pathologically confirmed (pN1) in 122 patients (28.8 %). When focusing the analyses on clinical characteristics (variables known before surgery), metastases at diagnosis [OR 3.0 (95 %1.9–4.8), p <0.001] and tumor size [OR 1.1 (95 % 1.1–1.2), p <0.001] were the two most informative predictors of concordance between clinical and pathological nodal status. Concordance was also more likely in patients with papillary type II tumors (55.6 %) relative to papillary type I (38.1 %), clear cell (27.7 %) and chromophobe (8.3 %) tumors. At multivariable analyses, none of the considered blood markers resulted to be independently associated with LNI. Conclusions: Roughly 70 % of patients showing a suspected lymph node preoperatively do not show LNI at the final pathological report. Among patients with clinically positive nodes, clinical tumor size and metastases at diagnosis represent the most informative and independent predictors of confirmed LNI at final pathology.

AB - Introduction: In renal cell carcinoma (RCC), lymph node status at preoperative imaging is affected by a non-negligible false-positive rate. We aimed to investigate which factors are related to a concordance between clinical suspicion and pathological confirmation of lymph node invasion (LNI). Methods: At a single tertiary care institution, 2954 RCC patients underwent either partial or radical nephrectomy. For the aim of the study, only clinically positive lymph node cases were included (cN1). Statistical analyses assessed the concordance between preoperative and pathological nodal status. Results: Preoperative axial CT scans revealed 424 (14.4 %) patients showing at least one enlarged lymph node suspected for LNI (cN1). All lymphadenopathies were removed at surgery, and LNI was pathologically confirmed (pN1) in 122 patients (28.8 %). When focusing the analyses on clinical characteristics (variables known before surgery), metastases at diagnosis [OR 3.0 (95 %1.9–4.8), p <0.001] and tumor size [OR 1.1 (95 % 1.1–1.2), p <0.001] were the two most informative predictors of concordance between clinical and pathological nodal status. Concordance was also more likely in patients with papillary type II tumors (55.6 %) relative to papillary type I (38.1 %), clear cell (27.7 %) and chromophobe (8.3 %) tumors. At multivariable analyses, none of the considered blood markers resulted to be independently associated with LNI. Conclusions: Roughly 70 % of patients showing a suspected lymph node preoperatively do not show LNI at the final pathological report. Among patients with clinically positive nodes, clinical tumor size and metastases at diagnosis represent the most informative and independent predictors of confirmed LNI at final pathology.

KW - Lymph node dissection

KW - Lymph node invasion

KW - Lymphadenectomy

KW - Renal cell carcinoma

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