1
|
Eismann L, Zucker M, Dawidek MT, Reese SW, Calderon LP, Aulitzky A, Stief CG, Coleman JA, Kotecha RR, Carlo M, Chen Y, Reznik E, Russo P, Ari Hakimi A. Surgical Outcomes and Genomic Insights of Nonclear Cell Renal Cell Carcinoma With Synchronous and Metachronous Nodal Disease. UROLOGY PRACTICE 2024; 11:860-870. [PMID: 38913557 PMCID: PMC11335441 DOI: 10.1097/upj.0000000000000623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/13/2024] [Indexed: 06/26/2024]
Abstract
INTRODUCTION Oncological outcomes in patients with nonclear cell renal cell carcinoma (non-ccRCC) treated with surgery for locoregional nodal disease (ND) remain incompletely characterized. The objective was to investigate the characteristics and outcomes of non-ccRCC patients treated with lymph node dissection (LND) and salvage-LND (S-LND). METHODS A total of 1627 patients underwent nephrectomy for nonmetastatic non-ccRCC at Memorial Sloan Kettering Cancer Center between 2007 and 2023. Histology was grouped as papillary, chromophobe, unclassified, and rare subtypes. Retrospective evaluation identified 2.5% (n = 40) of patients with nodal disease at time of nephrectomy (synchronous-ND) and 1.1% (n = 18) with metachronous nodal disease limited to the retroperitoneum (metachronous-ND). Patients' demographics and tumor characteristics were recorded and evaluated by univariate and multivariate cox regression models. Recurrence-free survival (RFS) and overall survival (OS) were estimated by the Kaplan-Meier method. Patients who underwent tumor DNA sequencing during their clinical course were considered for genomic analysis. RESULTS OS trended toward longer in metachronous-ND (51 vs 105 months; P = .2), though 23% of patients with synchronous-ND were recurrence-free at 45 months median follow-up. In multivariate analysis, rare histologies were associated with decreased OS (P = .030) and metachronous-ND with improved OS (P = .036). RFS and OS after S-LND was 15 and 96 months, respectively. Late onset of metachronous-ND/recurrence was associated with improved OS (P = .008). Genetic alterations in SETD2, TP53, B2M, and FGFR3 were exclusively seen in synchronous-ND, and tumor mutation burden (TMB) was also higher in patients with synchronous-ND (P = .016). CONCLUSIONS Patients with metachronous-ND tend to have prolonged OS compared to synchronous-ND, but a substantial portion of patients with synchronous-ND still enter a durable disease-free state following LND. S-LND can likewise provide long-term survival, particularly in patients with longer time to metachronous nodal recurrence. Synchronous-ND was associated with SETD2, TP53, and NF2 alteration as well as higher TMB.
Collapse
MESH Headings
- Humans
- Male
- Female
- Kidney Neoplasms/genetics
- Kidney Neoplasms/surgery
- Kidney Neoplasms/pathology
- Kidney Neoplasms/mortality
- Middle Aged
- Retrospective Studies
- Nephrectomy/methods
- Aged
- Carcinoma, Renal Cell/genetics
- Carcinoma, Renal Cell/surgery
- Carcinoma, Renal Cell/pathology
- Carcinoma, Renal Cell/mortality
- Lymph Node Excision
- Lymphatic Metastasis/genetics
- Lymphatic Metastasis/pathology
- Treatment Outcome
- Neoplasms, Multiple Primary/genetics
- Neoplasms, Multiple Primary/surgery
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Multiple Primary/mortality
- Genomics
- Adult
- Neoplasms, Second Primary/genetics
- Neoplasms, Second Primary/pathology
- Neoplasms, Second Primary/surgery
- Neoplasms, Second Primary/mortality
Collapse
Affiliation(s)
- Lennert Eismann
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Urology, University Hospital Munich, LMU, Munich, Germany
| | - Mark Zucker
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mark T. Dawidek
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stephen W. Reese
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lina Posada Calderon
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Urology, New York Presbyterian-Weill Cornell Medicine, New York, NY, USA
| | - Andreas Aulitzky
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Jonathan A. Coleman
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ritesh R. Kotecha
- Genitourinary Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria Carlo
- Genitourinary Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yingbei Chen
- Genitourinary Pathology, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eduard Reznik
- Department of Urology, New York Presbyterian-Weill Cornell Medicine, New York, NY, USA
| | - Paul Russo
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - A. Ari Hakimi
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
2
|
Al-Rusan OM, Patil D, Master VA, Osunkoya AO. A Contemporary Clinicopathologic Analysis of Patients With Renal Cell Carcinoma and Vena Cava Involvement. Int J Surg Pathol 2024; 32:279-285. [PMID: 37306114 DOI: 10.1177/10668969231177264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Renal cell carcinoma (RCC) is occasionally associated with vena cava involvement. Despite recent advances in therapeutic modalities, the 5-year survival in this population continues to be poor. Therefore, further studies are required to better characterize this patient population, especially from the clinicopathologic standpoint. A comprehensive review of patients with RCC and vena cava involvement managed at our institution from 2014 to 2022 was performed. Multiple clinicopathologic parameters including follow-up were obtained. A total of 114 patients were identified. The mean patient age was 63 years (range: 30-84 years). The cohort consisted of 78/114 (68%) males and 36/114 (32%) females. The mean primary tumor size (excluding tumor thrombus) was 11 cm. The majority of tumors (104/114, 91%) were unifocal. Tumor stages were categorized as follows: pT3b (51/114, 44%), pT3c (52/114, 46%), and pT4 (11/114, 10%). Most of the tumors were clear cell RCC 89/114 (78%), although other more aggressive RCC subtypes were also present. Most tumors were WHO/ISUP grade 3 (44/114, 39%) or 4 (67/114, 59%) with sarcomatoid differentiation present in 39/67 (58%). Necrosis was present in 94/114 (82%) tumors. Twenty-three of 114 (20%) tumors were categorized as pM1 and the ipsilateral adrenal gland was the most common site of metastasis. Of the 91 patients categorized as pM, not applicable at nephrectomy, 42/91 (46%) subsequently developed metastasis, most frequently to the lung. Of all patients, only 16/114 (14%) had positive vascular margins and 7/114 (6%) had positive soft tissue margins despite having very advanced disease and a subset considered inoperable at other centers.
Collapse
Affiliation(s)
- Omar M Al-Rusan
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Dattatraya Patil
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Adeboye O Osunkoya
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
- Department of Pathology, Veterans Affairs Medical Center, Decatur, GA, USA
| |
Collapse
|
3
|
Alkader MS, Altaha RZ, Jabali EH, Attieh OA, Matalqa AW. Is there an association between lymph node size and hyperprogression in immunotherapy-treated patients? ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2024; 62:33-43. [PMID: 37882575 DOI: 10.2478/rjim-2023-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Hyperprogressive disease (HPD) can be described as an accelerated increase in the growth rate of tumors combined with rapid clinical deterioration observed in a subset of cancer patients undergoing immunotherapy, specifically with immune checkpoint inhibitors (ICIs). The reported incidence of HPD ranges from 5.9% to 43.1% in patients receiving ICIs. In this context, identifying reliable predictive risk factors for HPD is crucial as it may allow for earlier intervention and ultimately improve patient outcomes. METHODS This study retrospectively analyzed ten metastatic renal cell carcinoma (mRCC) patients. The identification of HPD was based on the diagnostic criteria proposed by Ferrara R et al. This study aimed to investigate whether there is an association between LN size and HPD using a cutoff value of 3 cm for LN size. Given the limited sample size, Fisher's exact test was used to test this association. We conducted a Kaplan-Meier (KM) analysis to estimate the median overall survival (OS) of patients with HPD and compared it to those without HPD. RESULTS Three patients (30%) developed HPD, while seven (70%) did not. Fisher's exact test revealed a statistically significant association between the HPD and LN size ≥ 3 cm (p=0.008). In the HPD group, the median OS was significantly shorter, with a median OS of 3 months, whereas in the non-HPD group, the median OS was not reached (P =0.001). CONCLUSION The present study found a significant association between LN size ≥ 3 cm in the pretreatment period and HPD development.
Collapse
Affiliation(s)
- Mohammad S Alkader
- Department of Clinical Oncology, Military Cancer Center, Royal Medical Services, Amman, Jordan
| | - Rashed Z Altaha
- Department of Internal Medicine, Military Cancer Center, Royal Medical Services, Amman, Jordan
| | - Eslam H Jabali
- Department of nuclear medicine, Royal Medical Services, Amman, Jordan
| | - Ola A Attieh
- Department of nuclear medicine, Royal Medical Services, Amman, Jordan
| | - Ala' W Matalqa
- Department of Internal Medicine, Military Cancer Center, Royal Medical Services, Amman, Jordan
| |
Collapse
|
4
|
Ngai M, Chandrasekar T, Bratslavsky G, Goldberg H. The Current Role of Lymph Node Dissection in Nonmetastatic Localized Renal Cell Carcinoma. J Clin Med 2023; 12:jcm12113732. [PMID: 37297925 DOI: 10.3390/jcm12113732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/21/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
PURPOSE To explore the current role of lymph node dissection (LND) in the management of nonmetastatic localized renal cell carcinoma (RCC). BACKGROUND There is currently no proven benefit of LND in the setting of RCC, and its role remains controversial because of conflicting evidence. Patients who may benefit from LND are those at greatest risk of nodal disease, but the tools used to predict nodal involvement are limited due to unpredictable retroperitoneal lymphatics. The indications, templates, and extent of LND are also not standardized, adding to the ambiguity of current guidelines surrounding its use. EVIDENCE ACQUISITION A PubMed search of the literature from January 2017 to December 2022 was conducted using the search terms "renal cell carcinoma" or "renal cancer" in combination with "lymph node dissection" or "lymphadenectomy". Case studies and editorials were excluded, whereas studies investigating the therapeutic effect of LND were classified as either demonstrating a benefit or no benefit. References of the studies and review articles were also searched for notable studies and findings that were outside the five-year literature search. The studies in this review were restricted to the English language. RESULTS Only a number of studies in recent years have found an association between the extent of LND and increased survival. Most studies do not indicate an associated benefit, and some even suggest a negative effect on survival. Most of these studies are retrospective. CONCLUSION The therapeutic value of LND in RCC is still unclear, and although prospective data are needed, its declining rates and emerging new therapies make this unlikely. A better understanding of renal lymphatics and improved detection of nodal disease may help determine the role of LND in nonmetastatic localized RCC.
Collapse
Affiliation(s)
- Megan Ngai
- Urology Department, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | | | - Gennady Bratslavsky
- Urology Department, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Hanan Goldberg
- Urology Department, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| |
Collapse
|
5
|
Kaldany A, Leopold ZR, Kim JE, Patel HV, Srivastava A, Tabakin AL, Singer EA. Dissecting the role of lymphadenectomy in the management of renal cell carcinoma: past, present, and future. KIDNEY CANCER JOURNAL : OFFICIAL JOURNAL OF THE KIDNEY CANCER ASSOCIATION 2020; 18:103-108. [PMID: 35069965 PMCID: PMC8772661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Lymph node involvement in renal cell carcinoma (RCC) portends a poor prognosis. However, the role of lymph node dissection (LND) at the time of tumor resection is not fully understood. Conflicting data have been published regarding the survival implications of LND during RCC surgery, and the optimal patient population for which LND might be beneficial has yet to be identified. Based on recent data characterizing the outcomes of node-positive RCC, some have advocated for revising the current staging guidelines to better reflect these findings. Given the paucity of high-quality evidence supporting or refuting the routine use of LND in RCC, further research is needed to shed light on this important topic. There are a number of ongoing clinical trials evaluating the role of perioperative (neoadjuvant and adjuvant) systemic therapy, which include patients with node-positive RCC, and will serve to guide changes in treatment practices for this patient population moving forward.
Collapse
Affiliation(s)
- Alain Kaldany
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Zev R. Leopold
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Juliana E. Kim
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Hiren V. Patel
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Arnav Srivastava
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Alexandra L. Tabakin
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Eric A. Singer
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| |
Collapse
|
6
|
Kapoor A, Kim J, Goucher G, Hoogenes J. Evolving Role of Urologists in the Management of Advanced Renal Cell Carcinoma. Urol Clin North Am 2020; 47:271-280. [PMID: 32600530 DOI: 10.1016/j.ucl.2020.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Advanced renal cell carcinoma is not uncommon, but necessitates a multidisciplinary approach for optimal treatment. Targeted therapy has increased the likelihood of urologists managing patients in all disease stages. Neoadjuvant therapy is currently experimental. Systemic therapy for metastatic disease demonstrates survival benefits. The role of cytoreductive nephrectomy and adjuvant therapy is dependent on patient selection. Management of advanced renal cell carcinoma involves continued optimization of available agents and biomarker development. This article reviews the role of the urologist in medical and surgical therapies, including prognostication, management of locally advanced and metastatic disease, and provides the most recent clinical trial data.
Collapse
Affiliation(s)
- Anil Kapoor
- Division of Urology, Department of Surgery, McMaster University, McMaster Institute of Urology, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Room G334, Hamilton, Ontario L8N 4A6, Canada.
| | - Jaehoon Kim
- Division of Urology, Department of Surgery, McMaster University, McMaster Institute of Urology, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Room G334, Hamilton, Ontario L8N 4A6, Canada
| | - George Goucher
- Division of Urology, Department of Surgery, McMaster University, McMaster Institute of Urology, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Room G334, Hamilton, Ontario L8N 4A6, Canada
| | - Jen Hoogenes
- Division of Urology, Department of Surgery, McMaster University, McMaster Institute of Urology, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Room G334, Hamilton, Ontario L8N 4A6, Canada
| |
Collapse
|
7
|
Malhotra P, Goel H, Mishra AK. Inflammatory lymphadenopathy in renal cell carcinoma: prognostic tool? ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:189. [PMID: 31205907 DOI: 10.21037/atm.2019.03.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Purnima Malhotra
- Department of Pathology, PGIMER & Dr RML Hospital, New Delhi, India
| | - Hemant Goel
- Department of Urology, PGIMER & Dr RML Hospital, New Delhi, India
| | - Ashwani Kumar Mishra
- Department of Biostatistics to National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences (AIIMS), New Delhi, India
| |
Collapse
|