Three or more pathologic positive lymph nodes distinguishes poor risk from favorable risk node-positive stage III renal cell carcinoma (RCC), investigators reported at the 38th Annual Congress of the European Association of Urology (EAU23).

Among 29,388 patients with RCC in the 2004-2019 National Cancer Database, 3910 (13.3%) had pN1 disease without distant metastasis. As the number of positive lymph nodes increased, so did the risk for all-cause mortality.

On Kaplan Meier analysis, 5-year overall survival rates for node-positive stage III RCC no longer differed significantly from nonmetastatic stage IV RCC once the number of positive lymph nodes reached a threshold of 3 or more, Cesare Saitta, MD, of the University of California San Diego Health System in La Jolla, reported on behalf of his team.

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The investigators refined the American Joint Committee on Cancer (AJCC) definition of pN1 to indicate 1-2 positive lymph nodes. They created a new pN2 category to indicate disease with 3 or more positive lymph nodes.

Using this revised stratification system, the 5-year overall survival rate was 69.4% for stage III pN0, 41.4% for stage III pN1, 31.8% for stage III pN2, and 30.0% for non-metastatic stage IV RCC. The risk for all-cause mortality was a significant 3.3-fold higher for the pN2 group vs 2.4-fold higher for the pN1 group, using the pT0 group as the reference, Dr Saitta reported.

Currently, AJCC stage III RCC includes both node-positive pN1 and node-negative pN0 disease. These study findings show that original pN1 RCC could be further subdivided into pN1 and pN2 disease with clinical significance. According to Dr Saitta’s team, the prognosis of pN2 disease is poor and comparable to non-metastatic stage IV pN0 RCC. 

“Although validation studies are warranted, consideration should be given towards stratifying stage III pN2 patients to a higher risk group,” the investigator concluded in a study abstract.


Wang L, Vaida F, Puri D, et al. Impact of number of positive lymph nodes on prognostic stratification in renal cell carcinoma: Analysis of the National Cancer Database. Presented at: EAU23, Milan, Italy, March 10-13. Abstract A0459.

This article originally appeared on Renal and Urology News