Clinical Significance of Tumor Size, Pathological Invasion Sites Including Urinary Collecting System and Clinically Detected Renal Vein Thrombus as Predictors for Recurrence in pT3a Localized Renal Cell Carcinoma.

Takuto Shimizu,Makito Miyake,Yasushi Nakai,Satoshi Anai,Nobumichi Tanaka,Kiyohide Fujimoto,Shunta Hori,Keiichi Sakamoto,Kazuki Ichikawa,Kota Iida,Tatsuki Miyamoto,Takeshi Inoue

doi:10.3390/diagnostics10030154

Takuto Shimizu, Makito Miyake + Show 10 more

Open Access

https://doi.org/10.3390/diagnostics10030154

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Journal: Diagnostics	Publication Date: Mar 12, 2020
Citations: 10	License type: CC BY 4.0

Affiliation: Nara Medical University

Abstract

The recent eighth tumor-node-metastasis (TMN) staging system classifies renal cell carcinoma (RCC) with perirenal fat invasion (PFI), renal sinus fat invasion (SFI), or renal vein invasion (RVI) as stage pT3a. However, limited data are available on whether these sites have similar prognostic value or recurrence rate. We investigated the recurrence rate based on tumor size, pathological invasion sites including urinary collecting system invasion (UCSI), and clinically detected renal vein thrombus (cd-RVT) with pT3aN0M0 RCC. We retrospectively reviewed 91 patients with pT3aN0M0 RCC who underwent surgical treatment. Patients with tumor size > 7 cm, UCSI, three invasive sites (PFI + SFI + RVI), and cd-RVT showed a significant correlation with high recurrence rates (hazard ration (HR) 2.98, p = 0.013; HR 8.86, p < 0.0001; HR 14.28, p = 0.0008; and HR 4.08, p = 0.0074, respectively). In the multivariate analysis, tumor size of >7 cm, the presence of UCSI, and cd-RVT were the independent predictors of recurrence (HR 3.39, p = 0.043, HR 7.31, p = 0.01, HR 5.06, p = 0.018, respectively). In pT3a RCC, tumor size (7 cm cut-off), UCSI, and cd-RVT may help to provide an early diagnosis of recurrence.

Highlights

Renal cell carcinoma (RCC) accounts for approximately 3% of all reported human cancers worldwide [1]
The recent eighth edition of the Union for International Cancer Control (UICC) tumor-nodemetastasis (TNM; 2017) classification system is currently used for staging renal cell carcinoma (RCC); pT stage is defined by Diagnostics 2020, 10, 154; doi:10.3390/diagnostics10030154
We identified 91 patients with pT3aN0M0 RCC of the 424 RCC patients who underwent surgery at our institute from 2007 to 2017

Summary

Introduction

Renal cell carcinoma (RCC) accounts for approximately 3% of all reported human cancers worldwide [1]. Brookman-May et al reported that the prognostic impact of PFI and RVI on CSS appeared to be comparable. They suggested that applying a 7 cm tumor size cut-off within another staging system may allow for enhanced prognostic discrimination of pT3a RCC [9]. RCC patients with UCSI should be paid more attention by clinicians and pathologists and require close follow-up for their poor prognosis [11] It is unclear whether the treatment of renal vein thrombus detected by preoperative image modality should be similar to that detected by postoperative pathological findings.

Patients Selection

Schematic representationofofthe the study workflow

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Patient Characteristics

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Discussion

Conclusions