Research article

The prognostic relevance of interactions between venous invasion, lymph node involvement and distant metastases in renal cell carcinoma after radical nephrectomy

Dragomir P Zubac¹ , Leif Bostad² , Tomas Seidal³ , Tore Wentzel-Larsen⁴ and Svein A Haukaas^1,5

¹  Department of Surgical Sciences, University of Bergen, Norway

²  Department of Pathology, Haukeland University Hospital, Bergen, Norway

³  Department of Pathology, Central Hospital, Karlstad, Sweden

⁴  Center for Clinical Research, Haukeland University Hospital, Bergen, Norway

⁵  Department of Surgery, Section of Urology, Haukeland University Hospital, Bergen, Norway

author email corresponding author email

BMC Urology 2008, 8:19doi:10.1186/1471-2490-8-19

Published:	19 December 2008

Abstract

Background

To investigate a possible prognostic significance of interactions between lymph node invasion (LNI), synchronous distant metastases (SDM), and venous invasion (VI) adjusted for mode of detection, Eastern Cooperative Oncology Group performance status (ECOG PS), erythrocyte sedimentation rate (ESR) and tumour size (TS) in 196 patients with renal cell carcinoma treated with radical nephrectomy.

Methods

Median follow-up was 5.5 years (mean 6.9 years; range 0.01–19.4). The mode of detection, ECOG PS, ESR and TS were obtained from the patients' records. Vena cava invasion and distant metastases were detected by preoperative imaging. The surgical specimens were examined for pathological stage, LNI and VI.

Results

The univariate analyses showed significant impact of VI, LNI, SDM, ESR and TS (p < 0.001), as well as mode of detection (p = 0.003) and ECOG PS (p = 0.002) on cancer specific survival. In multivariate analyses LNI was significantly associated with survival only in patients without SDM or VI (p < 0.001) with a hazard ratio of 9.0. LNI lost its prognostic significance when SDM or VI was present.

Conclusion

Our findings underline the prognostic importance of the status of the lymph nodes. LNI, SDM, ESR, and VI were independently associated with cancer specific survival after radical nephrectomy. LNI provided the strongest prognostic information for patients without SDM or VI whereas SDM and VI had strongest impact on survival when there was no nodal involvement.