MP50-01 PROGNOSTIC IMPACT OF PATHOLOGICAL RENAL PARENCHYMAL INFILTRATION IN NON-METASTATIC CLEAR CELL RENAL CELL CARCINOMA

Abstract

You have accessJournal of UrologyCME1 May 2022MP50-01 PROGNOSTIC IMPACT OF PATHOLOGICAL RENAL PARENCHYMAL INFILTRATION IN NON-METASTATIC CLEAR CELL RENAL CELL CARCINOMA Hajime Tanaka, Yuki Fukawa, Kouhei Yamamoto, Shohei Fukuda, Sho Uehara, Soichiro Yoshida, Minato Yokoyama, Yoh Matsuoka, Steven C. Campbell, and Yasuhisa Fujii Hajime TanakaHajime Tanaka More articles by this author , Yuki FukawaYuki Fukawa More articles by this author , Kouhei YamamotoKouhei Yamamoto More articles by this author , Shohei FukudaShohei Fukuda More articles by this author , Sho UeharaSho Uehara More articles by this author , Soichiro YoshidaSoichiro Yoshida More articles by this author , Minato YokoyamaMinato Yokoyama More articles by this author , Yoh MatsuokaYoh Matsuoka More articles by this author , Steven C. CampbellSteven C. Campbell More articles by this author , and Yasuhisa FujiiYasuhisa Fujii More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002625.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Previous studies highlighted the existence of heterogeneity in survival outcomes of patients with non-metastatic clear cell renal cell carcinoma (nmCCRCC), suggesting that further exploration is required to define high-risk patients. In this study, we investigated the prognostic impact of renal parenchymal infiltration (RPI) in nmCCRCC based on the pathological analysis with focus on the tumor interface with normal renal parenchyma. METHODS: We retrospectively analyzed 333 patients with nmCCRCC treated with radical nephrectomy. Two pathologists reviewed surgical specimens and determined the presence/absence of RPI, which was defined as tumor infiltration into the renal parenchyma by involving normal renal tissue and/or by forming small nests that were separate from the main lesion. Pathological TN stage (UICC version 8), microvascular invasion, and WHO/ISUP grade were also evaluated and the impacts of those parameters on recurrence-free survival (RFS) were analyzed. RESULTS: The median age was 64 and 232 patients (70%) were male. The pathological analysis revealed invasions into perirenal fat, sinus fat, collecting system, and renal vein in 30 (9%), 33 (10%), 30 (9%), and 60 (18%) patients, respectively, resulting in 107 patients (32%) with ≥pT3a. Microvascular invasion was identified in 199 patients (60%) and 138 (41%) had WHO/ISUP grade 3-4. Overall 40 patients (12%), including 24 with ≥pT3a and 16 with pT1-2, were diagnosed with RPI.During the median follow-up of 6.0 years, 67 patients (20%) developed recurrence. In the multivariable analysis, ≥pT3a, microvascular invasion, WHO/ISUP grade 3-4, and RPI were independently associated with shorter RFS. The hazard ratio was highest for RPI (5.41 [95% CI: 3.10-9.44]) followed by microvascular invasion (3.04 [1.26-7.30]), WHO/ISUP grade (2.16 [1.20-3.87]), and ≥pT3a (2.13 [1.23-3.70]). According to pT stage and RPI, 5-year RFS was 17%, 40%, 76%, and 94% in the patients with ≥pT3a and RPI(+), pT1-2 and RPI(+), ≥pT3a and RPI(-), and pT1-2 and RPI(-), respectively (p<0.001). CONCLUSIONS: RPI is the primary determinant of poor prognosis in nmCCRCC among pathological parameters related to stage and grade. The presence of RPI predicts a high risk of recurrence early after surgery and adjuvant therapy may be considered for this population. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e863 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hajime Tanaka More articles by this author Yuki Fukawa More articles by this author Kouhei Yamamoto More articles by this author Shohei Fukuda More articles by this author Sho Uehara More articles by this author Soichiro Yoshida More articles by this author Minato Yokoyama More articles by this author Yoh Matsuoka More articles by this author Steven C. Campbell More articles by this author Yasuhisa Fujii More articles by this author Expand All Advertisement PDF DownloadLoading ...