Is nodal disease burden relevant in patients with renal cell carcinoma and lymph node invasion?

Lymph node (LN) metastases confer poor prognosis in the vast majority of malignancies and renal cell carcinoma (RCC) is not an exception. Previously, we and other groups have demonstrated that LN invasion is associated with decreased survival in patients with locally advanced RCC (1). In a recent publication, Yu and colleagues analyzed an institutional database of 912 patients with stage III RCC. They found that the outcome of those having nodal involvement was significantly worse than those without nodal involvement and similar to patients with stage IV RCC (2). Ten-year overall survival (OS) described by prior series ranges between 15% and 26% (3,4). However, the results of such series are based on retrospective analysis evaluating the presence or absence of LN metastases as a dichotomic prognostic factor instead of considering the number of positive LN affected by tumor (nodal disease burden).