Contemporary outcomes of pT3 renal cell carcinoma: A Canadian multi-institutional experience.

Abstract

434 Background: A large, multi-institutional analysis was undertaken to examine the pathological and oncological outcomes for patients with pT3 renal cell carcinoma (RCC) treated surgically. Materials and Methods: Institutional databases on patients surgically treated for RCC were obtained from 14 centers across 6 Canadian provinces forming the Canadian Kidney Cancer Information System (CKCis) database. Data were collected on 2204 patients and included patient characteristics, peri-operative information, pathological and oncological outcomes. Results: Of the 2,204 patients, 498 (22.6%) patients had pT3 disease according to the 2009 TNM staging system. Mean pathological tumor size was 8.6 cm. 443 (89.0%) patients underwent a radical nephrectomy (RN) and 55 (11.0%) underwent a partial nephrectomy (PN). Of those treated with RN, 247 (55.8%) were open, 159 (35.9%) laparoscopic and 1 (0.2%) robotic. In the PN group, 37 (67.3%), 14 (25.5%) and 4 (7.3%) patients were treated open, laparoscopic and robotically, respectively. Average operative time was 184 mins, with an average blood loss of 650 cc. Of the pT3 lesions, 365 (73.3%) were pT3a, 97 (19.5%) pT3b and 12 (2.4%) pT3c. 109 (22%) patients had a metastatic diagnosis before or at the time of nephrectomy. Of the remaining 389 patients, 68.9% remained free of disease after a median follow-up of 1.3 years. Common sites of metastatic disease included lung, lymph nodes and bone (77%, 35%, and 25%, respectively). Clear cell RCC was the predominant histopathology (74%). There were no peri-operative (<30 days) mortalities. Complications were found in 14.1% of patients. Systemic therapy was initiated in 132 (26.5%) of patients, most commonly with Sunitinib in 106 (80%) patients. Conclusions: Locally advanced, pT3 renal cell carcinoma is an aggressive disease that is associated with high rates of metastatic disease. Despite this, a significant portion remained disease free at the time of our follow-up.