A recent study published in the journal Cancer last month compared the survival of 8,988 kidney cancer patients from the American National Cancer Data Base to assess the impact of cancer spread to the lymph nodes in patients with stage III renal cell carcinoma (RCC).
The researchers found that the 5-year survival rate of patients with cancer spread to their lymph nodes (lymph node-positive stage III disease) was 23% and was more like that of patients with stage IV disease (16%) than patients with lymph node-negative stage III disease (62%).
This study may help to explain the lack of survival benefit with adjuvant therapy in patients with stage III RCC and positive lymph nodes, particularly adjuvant therapy with TKIs (e.g. the ASSURE trial). Also, it may help to explain outcomes in stage III patients who have surgical removal of their positive lymph nodes and survival similar to that of patients with stage IV disease.
In conclusion, the results from this study support the finding that patients with lymph node–positive stage III RCC have a poor prognosis, with survival similar to that of patients with stage IV disease, and these patients should be reclassified as stage IV RCC. However, further validation of these findings is needed before changing national staging guidelines.