Presentation Authors: Arnav Srivastava*, Zorimar Rivera-Nunez, Sinae Kim, Joshua Sterling, Nicholas Farber, Kushan Radadia, Parth Modi, Sharad Goyal, Rahul Parikh, Tina Mayer, Biren Saraiya, Robert Weiss, Isaac Kim, Sammy Elsamra, Thomas Jang, Eric Singer, New Brunswick, NJ
Introduction: Stage III renal cell carcinoma (RCC) encompasses both node-positive (pT1-3N1M0) and node-negative (pT3N0M0) disease. However, prior institutional studies have indicated that among Stage III patients, those with nodal disease have significantly worse oncologic outcomes. Instead they experience survival similar to patients with Stage IV disease. Our study aims to validate these findings using a large, nationally representative sample of kidney cancer patients in order to further inform current RCC staging.
Methods: Using the National Cancer Database (NCDB) patients with Stage III or IV RCC were identified. Patients were categorized as Stage III node-positive (pT1-3N1M0), Stage III node-negative (pT3N0M0) disease or Stage IV metastatic disease (pT1-4N0M1). Cox proportional hazard models compared outcomes while adjusting for comorbidities. Kaplan Meier estimates illustrated relative survival when comparing each patient group.
Results: 19,958 patients identified from the NCDB met inclusion criteria, with n = 9996 Stage III node-negative disease, n = 4052 Stage III node-positive disease, and n= 257 Stage IV disease. Patients with Stage III node-negative disease had significantly improved overall survival (Median Survival = 79.5 months (95%CI = 75.9 â€“ 83.1)) versus their counter parts with nodal disease (Median Survival = 18.6 months (95%CI = 17.5 â€“ 19.6)). Additionally, Stage III node-positive patient had a similar survival curve but slightly worse outcomes versus those with Stage IV disease (Median Survival = 24.4 months (95%CI = 22.3 â€“ 26.5)). (Figure 1).
Conclusions: Current staging by the American Joint Committee on Cancer groups pT1-3N1M0 and pT3N0M0 as Stage III disease. However, our validation study â€“ in agreement with prior smaller institutional studies â€“ suggests the need for further stratification and even placement of pT1-3N1M0 patients into Stage IV. Pathologic staging that accurately reflects oncologic prognosis may help clinicians better counsel and select patients who will derive the most benefit from lymphadenectomy, adjuvant systemic therapy, and more rigorous imaging surveillance.