From the Guidelines
Lymph node metastasis to the perinephric fat anterior to the psoas muscle below the lower pole of the kidney is uncommon in stage 1 Chromophobe Renal Cell Carcinoma (ChRCC) kidney cancer. This is because ChRCC is generally less aggressive than other kidney cancer subtypes, with a lower tendency to metastasize, as noted in the NCCN clinical practice guidelines in oncology: kidney cancer 1.
Key Points
- Stage 1 kidney cancers, by definition, are confined to the kidney (less than 7 cm in size) without spread to lymph nodes or distant sites.
- The 5-year survival rate for localized ChRCC exceeds 90%, reflecting its indolent nature, with an estimated average 5-year survival rate of 96% for patients with stage I disease 1.
- Treatment for stage 1 ChRCC usually involves partial or radical nephrectomy without the need for lymph node dissection unless there are suspicious findings on imaging, as surgical resection remains the only effective therapy for clinically localized RCC 1.
- Regular surveillance with imaging after surgery is recommended, typically including CT scans every 6-12 months for the first few years, then annually for at least 5 years.
Considerations
- The retroperitoneal area contains lymphatic drainage pathways for the kidney, but metastasis there would typically occur only in more advanced disease.
- Although lymph node dissection is not considered therapeutic, it provides prognostic information, because virtually all patients with nodal involvement subsequently relapse with distant metastases despite lymphadenectomy 1.
From the Research
Lymph Node Metastasis in Chromophobe Renal Cell Carcinoma
- There is limited information available on lymph node metastasis to the perinephric fat anterior to the psoas muscle below the lower pole of the kidney in stage 1 Chromophobe Renal Cell Carcinoma (ChRCC) kidney cancer.
- The provided studies do not specifically address this topic, but they do discuss the rarity and characteristics of ChRCC, as well as its potential for metastasis 2, 3, 4, 5, 6.
- ChRCC is known to have a low risk of developing metastatic disease, with a favorable prognosis overall 2, 3.
- However, cases of metastasis to various regions, including the head and neck, have been reported, highlighting the importance of long-term follow-up and individualized treatment approaches 4.
- The studies suggest that ChRCC with sarcomatoid differentiation or larger tumors may have a more aggressive clinical course and poorer outcomes 6, but do not provide specific information on lymph node metastasis to the perinephric fat.
- Further research is needed to determine the frequency and characteristics of lymph node metastasis in stage 1 ChRCC, particularly in the specified location.