Year-end Sale % OFF 
Abstract
ObjectivesWe aimed to determine preoperative risk factors associated with pathologic T3a (pT3a) upstaging of clinical T1 (cT1) renal cell carcinomas (RCCs) and develop a novel model capable of accurately identifying those patients at high risk of harboring occult pT3a characteristics.MethodsA retrospective analysis of 1324 cT1 RCC patients who underwent partial nephrectomy (PN) or radical nephrectomy (RN) was performed. The study cohort was divided into training and testing datasets in a 70:30 ratio for further analysis. Univariable and multivariable logistic regression analyses were performed to identify predictors associated with cT1 to pT3a upstaging and subsequently, those significant risk factors were used to construct models. We used the area under the curve (AUC) to determine the model with the highest discrimination power. Decision curve analyses (DCAs) were applied to evaluate clinical net benefit associated with using the predictive models.ResultsThe rates of upstaging were 6.1% (n = 81), 5.8% (n = 54) and 6.8% (n = 27) in the total population, training cohort and validation cohort, respectively. Tumor size, clinical T stage, R.E.N.A.L. (radius, exophytic/endophytic properties, nearness of tumor to collecting system or sinus, anterior/posterior) nephrometry score, lymphocyte to monocyte ratio (LMR), prognostic nutrition index (PNI) and albumin to globulin ratio (AGR) were significantly associated with pT3a upstaging. The model that consisted of R.E.N.A.L. score, LMR, AGR and PNI achieved the highest AUC of 0.70 in the validation cohort and yielded the highest net benefit. In the subpopulation with complete serum lipid profile, the inclusion of low-density lipoprotein cholesterol (LDL-C) and Castelli risk index-I (CRI-I) significantly improved the discrimination of model (AUC = 0.86).ConclusionsOur finding highlights the importance of systemic inflammation response markers and serum lipid parameters in predicting pT3a upstaging. Our model had relatively good discrimination in predicting occult pT3a disease among patients with cT1 renal lesions, and the use of the model may be greatly beneficial to urologists in risk stratification and management decisions.
Highlights
The majority of patients diagnosed with renal cell carcinomas (RCCs) tend to harbor small, organ-confined tumors due to the increased use of abdominal cross-sectional imaging [1]
The model that consisted of R.E.N.A.L. score, lymphocyte to monocyte ratio (LMR), albumin to globulin ratio (AGR) and prognostic nutrition index (PNI) achieved the highest area under the curve (AUC) of 0.70 in the validation cohort and yielded the highest net benefit
Our finding highlights the importance of systemic inflammation response markers and serum lipid parameters in predicting pathologic T3a (pT3a) upstaging
Summary
The majority of patients diagnosed with RCC tend to harbor small, organ-confined tumors due to the increased use of abdominal cross-sectional imaging [1]. PN has become the standard treatment for clinical stage T1a (cT1a) masses, suggesting its better functional outcomes compared to RN, without compromising cancer control [3, 4]. Among those patients who undergo PN or RN for cT1 masses, up to 4– 13% may have occult adverse pathological features, such as perirenal or sinus fat invasion [5,6,7,8,9,10,11]. Tumor upstaging poses a clinical dilemma in refining patient selection for the surgical management of cT1 RCC. It is of great importance to accurately identify those cT1 patients at high risk for pT3a upstaging prior to surgery
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
