Factors related to lymph node sampling at the time of surgery in children, adolescents, and young adults with unilateral non-metastatic renal cell carcinoma

Summary Introduction Renal cell carcinoma (RCC) is rare in the pediatric, adolescent, and young adult (PAYA) population. PAYA patients with RCC have a high rate of lymph node (LN) involvement, regardless of primary tumor size, yet data to guide surgical LN management in this group are limited. Objective The objective of this study was to determine what factors are associated with LN sampling (protocol adherence) in PAYAs with RCC. Methods The National Cancer Database (NCDB) between 2004 and 2013 was queried for patients aged ≤30 yrs with non-metastatic, unilateral RCC managed with surgery. Logistic regression analyses were performed to evaluate factors associated with LN sampling. Results A total of 2857 patients met study criteria. Pathologically, 2510 (87.8%) patients were Nx, 278 (9.7%) N0, and 69 (2.4%) N1. Older age was associated with omission of LN sampling (odds ration [OR]: 1.065, 95% confidence interval [CI]: 1.04–1.1, P 10 cm (OR: 0.27, 95% CI: 0.12–0.57, P = 0.001), and radical nephrectomy (OR: 0.245, 95% CI: 0.16–0.38, P Discussion Lymph node sampling is performed in Data from administrative databases are helpful for rare diseases such as PAYA RCC, but comes with limitations such as missing data. There are several factors that could contribute to LN sampling utilization (National comprehensive cancer network (NCCN) or Children's Oncology Group institution designation, surgeon experience, annual volume, specialty, operative approach, etc.) that cannot be further examined using the NCDB. Conclusion Pediatric, adolescent, and young adult patients with localized RCC are less likely to undergo surgical LN sampling if they are older, have tumors Univariate and multivariate analyses of factors associated with omission of LN sampling (pNx status). Factor Univariate Multivariate OR 95% CI P-value OR 95% CI P-value Facility case volume (continuous) 0.984 0.975–0.993 0.971 0.957–0.986 Age at diagnosis (continuous) 1.109 1.087–1.132 1.065 1.036–1.096 Gender Male 1 Female 0.822 0.656–1.029 0.088 Race White 1 1 Black 0.401 0.305–0.526 0.789 0.531–1.173 0.242 Other 1.106 0.601–2.035 0.745 1.573 0.647–3.829 0.318 Unknown 0.532 0.232–1.219 0.136 0.977 0.271–3.516 0.971 Insurance Private 1 1 Government 0.81 0.626–1.047 0.108 1.242 0.858–1.798 0.251 None 0.868 0.569–1.324 0.51 1.396 0.742–2.628 0.301 Unknown 0.438 0.254–0.755 0.003 0.504 0.195–1.304 0.158 Laterality Right 1 1 Left 0.709 0.565–0.889 0.003 0.744 0.542–1.02 0.066 Histology Papillary RCC 1 1 Clear cell RCC 3.671 2.573–5.237 1.649 0.994–2.737 0.053 RCC NOS RCC 1.596 1.133–2.249 0.008 0.28 0.783–2.093 0.325 Cyst-associated RCC 2.172 0.633–7.458 0.218 0.768 0.177–3.332 0.725 Chromophobe RCC 1.372 0.917–2.052 0.124 1.402 0.781–2.516 0.258 Sarcomatoid RCC 0.099 0.030–0.321 0.164 0.016–1.707 0.13 Stage 1 1 1 2 0.164 0.122–0.22 0.637 0.299–1.357 0.243 3 0.057 0.041–0.078 0.192 0.113–0.326 Tumor size ≤4 cm 1 1 4–≤7 cm 0.461 0.341–0.622 0.765 0.510–1.15 0.198 7–≤10 cm 0.171 0.120–0.244 0.510 0.233–1.114 0.091 >10 cm 0.074 0.053–0.104 0.266 0.124–0.567 0.001 Clinical nodal status cN0 1 1 cN1 0.052 0.023–0.115 0.320 0.119–0.86 0.0224 Type of surgery Partial nephrectomy 1 1 Radical nephrectomy 0.130 0.096–0.178 0.245 0.159–0.377 CI, confidence interval; LN, lymph node; OR, odds ratio; RCC, renal cell carcinoma.