Lymph node yield in pediatric, adolescent and young adult Renal Cell Carcinoma – How many are enough?
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In brief
In brief
Study of 112 pediatric and young adult RCC patients establishes that sampling at least 5 lymph nodes reduces the risk of missing occult nodal involvement to ≤10%. Findings support standardized surgical guidelines for lymph node management in this high-risk population with elevated rates of nodal metastases.
Written by the GCMD Library team from the article.
Purpose
Pediatric, adolescent and young adult (PAYA) patients with renal cell carcinoma (RCC) have a high rate of LN involvement, yet data to guide surgical lymph node (LN) management in this group is limited. The objective is to describe a LN yield threshold to quantify the chance of missing occult LN involvement at ≤10% in PAYAs with RCC.
Materials & methods
The National Cancer Database was queried for patients aged ≤30 y with unilateral, non-metastaticRCC from 2004 to 2013. The probability of a false negative LN sampling was determined on the cohort of patients who had at least one positive LNand ≥ 2 LNs examined. For a given LN yield, the probability that a positive LN exists but none were found was estimated using a beta-binomial model.
Results
We identified 112 patients meeting study criteria. Median age was 24 y and median tumor size was 9.5 cm (IQR 5.8–14). The median number of LNs sampled was 7 (IQR 4–12) and the median number of LNs positive was 4 (IQR 2–7). To achieve ≤10% probability of a false-negativeLN sampling, the beta-binomial model estimated that 5 LNs (95% CI4–7) must be sampled.
Conclusions
The desired LN yield to reduce the risk of a false-negativeLN sampling in PAYAs with RCC to ≤10% is 5. This is in keeping with prior studies identifying a LN yield of 6–10 to achieve the same. These data may be used to standardize surgical guidelines when treating PAYAs with renal tumors.
Level of Evidence
II.