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

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.