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Renal neoplasm: The prognostic significance of nodal involvement

– Histologically-proven positive nodal involvement has a markedly negative affect on the prognosis of patients subjected to surgery for renal neoplasm. The incidence of nodal metastases reported in literature is wide-ranging and depends on various factors. A critical retrospective evaluation of literature in terms of survival curves and prognostic factor analysis highlights a particularly heterogeneous picture, due to much methodological bias and frequent violation of assumptions of the statistical analyses used. All these factors prevent a precise, independent prognostic value from being assigned to nodal involvement. The results of the single randomised prospective study (protocom EORTC 30881) on the therapeutic effectiveness of lymphadenectomy have been weakened by the low reported incidence of nodal involvement (about 5%). One of the most plausible explanations for this is the change in the natural history of renal tumours, which are currently diagnosed at low volume and stage, with a consequently low rate of nodal and/or distant metastases. This change in the natural history of the disease has increased the frequency of non-elective nephron-sparing surgery with optional nodal dissection over the last few years. This new approach has weakened the traditionally recognised role of lymphadenectomy in staging the disease.