Renal Cell Carcinoma and Pathologic Nodal Disease: Implications for American Joint Committee on Cancer Staging

BACKGROUND: Lymph node (LN) metastases are associated with poor outcomes for patients with renal cell carcinoma (RCC). This study compared the survival outcomes of patients with stage III, node-positive disease (pT(123)N(1)M(0)) and patients with stage III, node-negative disease (pT(3)N(0)M(0)). METHODS: A database of 4652 patients with RCC of any histological subtype treated with surgery at The University of Texas MD Anderson Cancer Center from 1993 to 2012 was retrospectively assessed. A total of 115 patients with pT(123)N(1)M(0) disease, 274 patients with pT(3)N(0)M(0) disease, and 523 patients with pT(123)N(0/x)M(1) disease were included. Overall survival (OS) and cancer-specific survival (CSS) were estimated and compared between each cohort. RESULTS: Median OS and CSS times were significantly better for pT(3)N(0)M(0) patients than pT(123)N(1)M(0) patients (OS, 10.2 vs 2.4 years, P < .0001; CSS, not reached vs 2.8 years, P < .0001). Similar median OS and CSS times were noted for pT(123)N(1)M(0) and pT(123)N(0/x)M(1) patients (OS, 2.4 vs 2.4 years; P = .62; CSS, 2.8 vs 2.4 years; P = .10). In a multivariate analysis, tumor grade (hazard ratio [HR] for OS, 2.47; P < .0001; HR for CSS, 2.99; P < .0001) and pathologic LN involvement (HR for OS, 2.44; P < .0001; HR for CSS, 2.85; P < .0001) were associated with worse OS and CSS. CONCLUSIONS: Among RCC patients classified with stage III disease, those with pT(123)N(1)M(0) disease had significantly worse survival than those with pT(3)N(0)M(0) disease. OS and CSS were similar for patients with pT(123)N(1)M(0) disease and patients with pT(123)N(0/x)M(1) disease (stage IV). If validated, these findings suggest that RCC patients with nodal disease should be reclassified as having stage IV disease. (C) 2018 American Cancer Society.