From the Research
Lymph node metastasis from kidney cancer in the fat anterior to the psoas muscle below the lower pole of the kidney is not uncommon. This area contains lymphatic drainage pathways that can be involved in the spread of renal cell carcinoma. When kidney cancer metastasizes, it frequently spreads through lymphatic channels to regional lymph nodes, including those in the perirenal fat, para-aortic region, and around the renal hilum. The lymph nodes anterior to the psoas muscle, particularly those below the lower pole of the kidney, are considered regional nodes and are often evaluated during surgical staging of kidney cancer. The likelihood of metastasis to these nodes increases with higher tumor stage, grade, and size. Some key points to consider include:
- The presence of lymph node involvement in kidney cancer doubles a patient's risk of distant metastasis and significantly reduces their 5-year survival 1.
- Imaging studies such as CT with contrast or MRI are essential for detecting lymph node involvement in this area during initial staging and surveillance.
- A machine learning model can accurately predict the probability of lymph node metastasis in patients with kidney cancer, with factors such as pathological grade, liver metastasis, M staging, primary site, T staging, and tumor size being independent predictive factors of lymph node metastasis 2.
- Lymph node metastasis is an essential prognostic indicator in many different types of cancer, including kidney cancer, and understanding the mechanisms of tumor cells to metastasize to lymph nodes is crucial for providing patients with accurate disease assessment and effective treatment strategies 3. Patients with lymph node involvement typically require more aggressive treatment approaches, which may include radical nephrectomy with regional lymphadenectomy, targeted therapy, immunotherapy, or a combination of these modalities. It is essential to approach lymphadenectomy and nodal irradiation with caution, particularly in patients receiving immunotherapy, as it may deter further metastatic spread and induce metastatic tolerance 4.