Study Suggest Expanding Definition of Stage IV Kidney Cancer to Include Lymph Node–positive RCC

Patients with lymph node–positive (pT1‐3N1M0) renal cell carcinoma (RCC) should potentially be placed in the stage IV category to better reflect oncologic prognosis and guide treatment, according to a study published in the journal Cancer.

Using the National Cancer Data Base (NCDB), patients with American Joint Committee on Cancer (AJCC) stage III or stage IV RCC were separated into lymph node–positive stage III (pT1‐3N1M0), lymph node–negative stage III (pT3N0M0), or stage IV metastatic (pT1‐3 N0M1) disease.

Five-year survival rates between patients with lymph node–positive stage III and stage IV RCC were similar, whereas patients with lymph node–negative stage III disease had better survival compared to the other groups (22.7%, 15.6%, and 61.9%, respectively).

The authors concluded that although the current staging system groups patients with pT1‐3N1M0 and pT3N0M0 RCC as stage III disease, this validation study indicated patients with pT1‐3N1M0 RCC should be placed in the stage IV category. Further stratification is needed.

“Staging that accurately reflects oncologic prognosis may help clinicians better counsel and select patients who might derive the most benefit from lymphadenectomy, adjuvant systemic therapy, more rigorous imaging surveillance, and clinical trial participation,” the authors wrote.

Reference

Impact of pathologic lymph node–positive renal cell carcinoma on survival in patients without metastasis: Evidence in support of expanding the definition of stage IV kidney cancer. Cancer. 2020. doi: 10.1002/cncr.32912. Online ahead of print.