Accurate Risk Assessment of Patients with Pathologic T3aN0M0 Renal Cell Carcinoma

Jong Jin Oh,Seok-Soo Byun,Hakmin Lee,Sung Kyu Hong,Jung Keun Lee,Byung Do Song,Sang Eun Lee,Sangchul Lee

doi:10.1038/s41598-018-32362-w

Abstract

To develop a more precise risk-stratification system by investigating the prognostic impact of tumor growth within fatty tissues surrounding the kidney and/or renal vein. We conducted a retrospective review of the medical records of 211 patients with a pathologic diagnosis of T3aN0M0RCC among 4,483 renal cell carcinoma (RCC) patients from February 1988 to December 2015 according to the number of T3a pathologies—extrarenal fat invasion (EFI) and/or renal venous invasion (RVI). During a mean follow-up duration of 38.8 months, the patients with both pathologies (EFI + RVI) had lower recurrence free survival (RFS) rate than those with only a single pathology (p = 0.001). Using multivariable Cox regression analysis, the presence of both factors was shown to be an independent predictor of RFS (HR = 1.964, p = 0.032); cancer specific survival rate was not different among patients with EFI and/or RVI. Patients with pathologic T3aN0M0 RCC presenting with both EFI and RVI were at an increased risk of recurrence following nephrectomy. Therefore, pathologic T3a RCC could be sub-divided into those with favorable and unfavorable disease according to presence of EFI and/or RVI pathologies.

Highlights

IntroductionIn the current staging system, T3a renal cell carcinoma (RCC) is defined as a tumor with extra-renal fat invasion (EFI) (perinephric or sinus fat invasion) and renal venous invasion (RVI) (renal vein or its segmental muscle containing branch)[9]
In the current staging system, T3a renal cell carcinoma (RCC) is defined as a tumor with extra-renal fat invasion (EFI) and renal venous invasion (RVI)[9]
After receiving institutional review board approval, we reviewed the data of all patients (n = 4,483) who underwent a partial or radical nephrectomy for RCC between February 1988 and December 2015 from two tertiary hospital (Seoul National University Hospital and Seoul National University Bundang Hospital)

Summary

Introduction

In the current staging system, T3a RCC is defined as a tumor with extra-renal fat invasion (EFI) (perinephric or sinus fat invasion) and renal venous invasion (RVI) (renal vein or its segmental muscle containing branch)[9]. The limited data available comparing the prognostic significance of EFI and/or RVI are inconsistent[10,11]. Some studies have suggest a significant impact of RVI on clinical outcome, while others have reported no prognostic value to the presence of tumor thrombus[12]. Other studies show that RCC with both EFI and RVI have higher recurrence rates than those with only EFI or RVI10. A T3a RCC tumor may have EFI and/or RVI and the prognostic significance of these characteristics is unclear. We hypothesize that T3 tumors with EFI and RVI are more aggressive than those with only EFI or RVI and have designed the current research study to compare the impact of these features in non-metastatic T3a tumors (ie, prognosis, survival)

Methods

Results

Conclusion