National utilization of regional lymph node dissection among patients with kidney cancer and clinical lymphadenopathy undergoing radical nephrectomy

Robert Abouassaly, Matthew J. Bream, Marc C. Smaldone, Alexander Kutikov, Nilay D. Shah, Christopher M. Gonzalez, Stephen Williams, Robert Houston Thompson, Stephen A. Boorjian, Simon P. Kim

    Research output: Contribution to journalArticle

    Abstract

    Introduction/background Regional lymph node dissection (LND) may provide oncologic benefit among patients with clinical lymphadenopathy in renal cell carcinoma (RCC) at the of time radical nephrectomy (RN). Yet, little is known about contemporary use of LND for patients with RCC and regional lymphadenopathy. Thus, we assessed national trends in RN and LND among RCC patients with renal masses and clinical lymphadenopathy. Materials and methods From the National Cancer Data Base (NCDB), we identified patients with RCC and clinical lymphadenopathy without distant metastasis (clinical T1-4 N1+ M0) who underwent RN from 2001 to 2011. The primary outcome was concomitant LND at the time of RN. Multivariable logistic regression analysis was used to identify patient and hospital characteristics associated with the primary outcome. Results Among 1840 patients with clinical N1+ treated surgically, 78% received LND (n=1444). The proportion of patients who underwent LND increased from 77% in 2001 to 82% in 2011 (p<0.01 for trend). On multivariable analysis, patients undergoing surgery at academic centers were more likely to undergo LND compared to those treated at community hospitals (OR: 1.59; p<0.01). In a subset of patients with surgical approach available, robotic or laparoscopic nephrectomy also correlated with lower use of RN and LND compared to open surgery (OR: 0.46; p<0.01). Conclusion Among patients with RCC and clinical lymphadenopathy, ~20% are not receiving LND at the time of RN in the U.S. Academic hospitals and open surgery was associated with receipt of LND. Centralization to tertiary academic hospitals may facilitate greater use of LND.

    Original languageEnglish (US)
    Pages (from-to)14-18
    Number of pages5
    JournalCancer Treatment and Research Communications
    Volume12
    DOIs
    StatePublished - 2017

    Fingerprint

    Kidney Neoplasms
    Lymph Node Excision
    Nephrectomy
    Renal Cell Carcinoma
    Lymphadenopathy
    Community Hospital
    Robotics
    Tertiary Care Centers
    Logistic Models
    Regression Analysis
    Databases
    Neoplasm Metastasis
    Kidney

    Keywords

    • Clinical lymphadenopathy
    • Kidney cancer
    • Lymph node dissection
    • Nephrectomy
    • Renal cell carcinoma

    ASJC Scopus subject areas

    • Oncology
    • Cancer Research

    Cite this

    National utilization of regional lymph node dissection among patients with kidney cancer and clinical lymphadenopathy undergoing radical nephrectomy. / Abouassaly, Robert; Bream, Matthew J.; Smaldone, Marc C.; Kutikov, Alexander; Shah, Nilay D.; Gonzalez, Christopher M.; Williams, Stephen; Thompson, Robert Houston; Boorjian, Stephen A.; Kim, Simon P.

    In: Cancer Treatment and Research Communications, Vol. 12, 2017, p. 14-18.

    Research output: Contribution to journalArticle

    Abouassaly, Robert ; Bream, Matthew J. ; Smaldone, Marc C. ; Kutikov, Alexander ; Shah, Nilay D. ; Gonzalez, Christopher M. ; Williams, Stephen ; Thompson, Robert Houston ; Boorjian, Stephen A. ; Kim, Simon P. / National utilization of regional lymph node dissection among patients with kidney cancer and clinical lymphadenopathy undergoing radical nephrectomy. In: Cancer Treatment and Research Communications. 2017 ; Vol. 12. pp. 14-18.
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    abstract = "Introduction/background Regional lymph node dissection (LND) may provide oncologic benefit among patients with clinical lymphadenopathy in renal cell carcinoma (RCC) at the of time radical nephrectomy (RN). Yet, little is known about contemporary use of LND for patients with RCC and regional lymphadenopathy. Thus, we assessed national trends in RN and LND among RCC patients with renal masses and clinical lymphadenopathy. Materials and methods From the National Cancer Data Base (NCDB), we identified patients with RCC and clinical lymphadenopathy without distant metastasis (clinical T1-4 N1+ M0) who underwent RN from 2001 to 2011. The primary outcome was concomitant LND at the time of RN. Multivariable logistic regression analysis was used to identify patient and hospital characteristics associated with the primary outcome. Results Among 1840 patients with clinical N1+ treated surgically, 78{\%} received LND (n=1444). The proportion of patients who underwent LND increased from 77{\%} in 2001 to 82{\%} in 2011 (p<0.01 for trend). On multivariable analysis, patients undergoing surgery at academic centers were more likely to undergo LND compared to those treated at community hospitals (OR: 1.59; p<0.01). In a subset of patients with surgical approach available, robotic or laparoscopic nephrectomy also correlated with lower use of RN and LND compared to open surgery (OR: 0.46; p<0.01). Conclusion Among patients with RCC and clinical lymphadenopathy, ~20{\%} are not receiving LND at the time of RN in the U.S. Academic hospitals and open surgery was associated with receipt of LND. Centralization to tertiary academic hospitals may facilitate greater use of LND.",
    keywords = "Clinical lymphadenopathy, Kidney cancer, Lymph node dissection, Nephrectomy, Renal cell carcinoma",
    author = "Robert Abouassaly and Bream, {Matthew J.} and Smaldone, {Marc C.} and Alexander Kutikov and Shah, {Nilay D.} and Gonzalez, {Christopher M.} and Stephen Williams and Thompson, {Robert Houston} and Boorjian, {Stephen A.} and Kim, {Simon P.}",
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    T1 - National utilization of regional lymph node dissection among patients with kidney cancer and clinical lymphadenopathy undergoing radical nephrectomy

    AU - Abouassaly, Robert

    AU - Bream, Matthew J.

    AU - Smaldone, Marc C.

    AU - Kutikov, Alexander

    AU - Shah, Nilay D.

    AU - Gonzalez, Christopher M.

    AU - Williams, Stephen

    AU - Thompson, Robert Houston

    AU - Boorjian, Stephen A.

    AU - Kim, Simon P.

    PY - 2017

    Y1 - 2017

    N2 - Introduction/background Regional lymph node dissection (LND) may provide oncologic benefit among patients with clinical lymphadenopathy in renal cell carcinoma (RCC) at the of time radical nephrectomy (RN). Yet, little is known about contemporary use of LND for patients with RCC and regional lymphadenopathy. Thus, we assessed national trends in RN and LND among RCC patients with renal masses and clinical lymphadenopathy. Materials and methods From the National Cancer Data Base (NCDB), we identified patients with RCC and clinical lymphadenopathy without distant metastasis (clinical T1-4 N1+ M0) who underwent RN from 2001 to 2011. The primary outcome was concomitant LND at the time of RN. Multivariable logistic regression analysis was used to identify patient and hospital characteristics associated with the primary outcome. Results Among 1840 patients with clinical N1+ treated surgically, 78% received LND (n=1444). The proportion of patients who underwent LND increased from 77% in 2001 to 82% in 2011 (p<0.01 for trend). On multivariable analysis, patients undergoing surgery at academic centers were more likely to undergo LND compared to those treated at community hospitals (OR: 1.59; p<0.01). In a subset of patients with surgical approach available, robotic or laparoscopic nephrectomy also correlated with lower use of RN and LND compared to open surgery (OR: 0.46; p<0.01). Conclusion Among patients with RCC and clinical lymphadenopathy, ~20% are not receiving LND at the time of RN in the U.S. Academic hospitals and open surgery was associated with receipt of LND. Centralization to tertiary academic hospitals may facilitate greater use of LND.

    AB - Introduction/background Regional lymph node dissection (LND) may provide oncologic benefit among patients with clinical lymphadenopathy in renal cell carcinoma (RCC) at the of time radical nephrectomy (RN). Yet, little is known about contemporary use of LND for patients with RCC and regional lymphadenopathy. Thus, we assessed national trends in RN and LND among RCC patients with renal masses and clinical lymphadenopathy. Materials and methods From the National Cancer Data Base (NCDB), we identified patients with RCC and clinical lymphadenopathy without distant metastasis (clinical T1-4 N1+ M0) who underwent RN from 2001 to 2011. The primary outcome was concomitant LND at the time of RN. Multivariable logistic regression analysis was used to identify patient and hospital characteristics associated with the primary outcome. Results Among 1840 patients with clinical N1+ treated surgically, 78% received LND (n=1444). The proportion of patients who underwent LND increased from 77% in 2001 to 82% in 2011 (p<0.01 for trend). On multivariable analysis, patients undergoing surgery at academic centers were more likely to undergo LND compared to those treated at community hospitals (OR: 1.59; p<0.01). In a subset of patients with surgical approach available, robotic or laparoscopic nephrectomy also correlated with lower use of RN and LND compared to open surgery (OR: 0.46; p<0.01). Conclusion Among patients with RCC and clinical lymphadenopathy, ~20% are not receiving LND at the time of RN in the U.S. Academic hospitals and open surgery was associated with receipt of LND. Centralization to tertiary academic hospitals may facilitate greater use of LND.

    KW - Clinical lymphadenopathy

    KW - Kidney cancer

    KW - Lymph node dissection

    KW - Nephrectomy

    KW - Renal cell carcinoma

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    DO - 10.1016/j.ctarc.2017.05.001

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    JF - Cancer Treatment and Research Communications

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