journal reading - preoperative lymp node

8/20/2019 journal reading - preoperative lymp node

1/19

Widya Sakti Pratama


2/19

Background

• Approximately 2.7% to 10% ofpatients it! "## !a$e lymp! nodemetastasis

• mpro$ed sur$i$al in patients it! "##!o underent "P&'(

• Patients it! only nodal metastasis

!o undergo a &' dissection atnep!rectomy may !a$e dura)ledisease*free sur$i$al


3/19

+aterial and +et!od

• "etrospecti$ely data)ase for patients it!"## it!out distant metastasis !ounderent radical or partial nep!rectomy

it! ,p-any p'0*1 +0 and it!out ,p-anyp'x +0 "P&'( )eteen 1// and 2012

• Symptom c!aracteriation as recordedas local or systemic

• A nomogram as de$eloped to predictt!e pro)a)ility of lymp! node metastasis


4/19


5/19

+aterial and +et!od

• systemic systems o fe$er3

o nig!t seats

o 4atigue

o eig!t loss greater t!an 10 pounds

• &ocal Symptomso 4lank paino5ematuria respiratory or gastrointestinal

complain


6/19

• #linically positi$e &'s ,c'1 ere

de6ned as retroperitoneallymp!adenopat!y greater t!an 1 cm oncross sectional imaging or enlarged &'sat surgery

• radiograp!ic information

– -umor

– &' sie

– -umor necrosis

– -!rom)us

– location


7/19

Statistical Analysis

• Analysis in patients !o underent"P&'( to determine signi6cantco$ariates )eteen t!ose it! p'1

and p'0

• A nomogram as de$eloped topredict t!e pro)a)ility of &'

metastasis in patients !ounderent "P&'(


8/19

Statistical Analysis

• utcome measures – $erall Sur$i$al

– #ancer Speci6c Sur$i$al

–

"ecurrence 4ree Sur$i$al• $erall Sur$i$al and #ancer Speci6c Sur$i$al

calculated in mont!s from t!e date ofsurgery to t!e date of last follo up or deat!

• "ecurrence free sur$i$al calculated inmont!s from t!e date of surgery to t!e dateof local and8or distant recurrence


9/19


10/19

"9S:&-

• We identi6ed 13270 patients it!renal cell carcinoma it!out distantmetastasis !o !ad ,;


11/19

• ;


12/19


13/19

(iscussion

• Patients it! "## it!out distantmetastasis !o ere selected for"P&'( local symptoms3 9#? PS 1

or greater3 c'1 stage and increased&(5 ere independent predictors of&' metastasis


14/19

• Patients it! clinically negati$e )utpat!ologically positi$e &'s ,c'0p'1!ad )etter S3 #SS and "4S t!an

patients it! clinically andpat!ologically positi$e &'s ,c'1p'1.


15/19


16/19


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18/19

#onclusions

• &ocal symptoms3 9#? PS3 c' stageand lactate de!ydrogenase ereindependent predictors of lymp! node

metastasis in patients !o underentretroperitoneal lymp! node dissection

• Predicti$e nomogram !ad >/%

discrimination and performed ellit! internal $alidation


19/19

#onclusions

• Patients it! clinically negati$e )utpat!ologically positi$e &'s representa small su)set of t!ose it! "## ,7%

in t!is co!ort

• -!e incidence of clinically positi$e)ut pat!ologically negati$e &'s

,7% is not insigni6cant

journal reading - preoperative lymp node

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