Abstract
PurposeTo identify the differences in oncological outcomes for patients with different pT3a renal tumor invasion patterns and pathological features.MethodsThe protocol of this study was registered on PROSPERO (CRD42021234475). Relevant studies were identified by searching the PubMed, Cochrane library, Embase, and Web of Science databases. Cancer-specific survival (CSS) was selected as the endpoint. Pooled hazard ratio (HR) and 95% confidence interval (CI) extracted from multivariate Cox models were evaluated to identify the hazard association.ResultsA total of 22 studies, which enrolled 12384 patients were included for quantitative synthesis. Sinus fat invasion (SFI) + perinephric fat invasion (PFI) was associated with inferior CSS compared to SFI only (p = 0.02). Comparable CSS was observed between SFI and PFI (p = 0.57). SFI ± PFI showed inferior CSS compared to PFI only (p = 0.0002). The presence of pelvicalyceal system invasion significantly increased the risk of cancer-specific mortality (p = 0.0005). Renal vein invasion (RVI) indicated poor oncological outcomes in terms of CSS (p = 0.002). The concomitant RVI and fat invasion (FI) significantly increased the risk of deterioration of CSS compared to RVI or FI (p < 0.0001). Multiple invasion patterns translated into a significantly decreased CSS (p < 0.0001). Aggressive tumor behavior, including lymph node involvement (p = 0.006), distant metastases (p < 0.00001), sarcomatoid differentiation (p < 0.0001), necrosis (p < 0.0001), Fuhrman grade III or IV (p < 0.0001), positive margin (p < 0.0001), and tumor size >7cm (p < 0.0001) were the predictors of inferior CSS. The lymphovascular invasion (p = 0.67) was indolent in terms of CSS.ConclusionThis study confirmed the heterogenicity of pT3a renal tumors. Multiple invasion patterns could translate into a significantly decreased CSS, and SFI should not be merged in the SFI + PFI group. The presence of PSI or RVI could significantly increase the risk of cancer-specific mortality. Lymph node involvement, distant metastases, sarcomatoid differentiation, necrosis, high Fuhrman grade, positive margin, and size >7cm were the predictors of inferior CSS. A precise-risk grade of CSS for different invasion patterns including comprehensive combinations may be useful for the further refinements of the TNM system.Systematic Review RegistrationThe current study was registered on PROSPERO, and the registration numbers is CRD42021234475.
Highlights
Since the publication of the sixth edition of the TNM staging system for renal tumors, the classification of T3a renal tumors has undergone several modifications
Sinus fat invasion (SFI) + perinephric fat invasion (PFI) was associated with inferior Cancer-specific survival (CSS) compared to sinus fat invasion (SFI) only (p = 0.02)
Currently pT3a is defined as a tumor confined to the Gerota’s fascia but exhibiting perinephric fat invasion (PFI), sinus fat invasion (SFI), renal vein invasion (RVI), or/and pelvicalyceal system invasion (PSI) regardless of tumor diameter, a realistic controversy is whether pT3a represents a heterogeneous histological group where different elements or a combination may indicate a significant difference in oncological prognosis
Summary
Since the publication of the sixth edition of the TNM staging system for renal tumors, the classification of T3a renal tumors has undergone several modifications. Currently pT3a is defined as a tumor confined to the Gerota’s fascia but exhibiting perinephric fat invasion (PFI), sinus fat invasion (SFI), renal vein invasion (RVI), or/and pelvicalyceal system invasion (PSI) regardless of tumor diameter, a realistic controversy is whether pT3a represents a heterogeneous histological group where different elements or a combination may indicate a significant difference in oncological prognosis. Several studies evaluating oncological outcomes for different pT3a renal tumor invasion patterns have failed to demonstrate the significant difference [3, 4]. It is important to accurately predict the prognosis of different pT3a renal tumor invasion patterns to guide the follow-up protocols and evaluate the effect of postoperative therapies on survival. Given the continuing controversy over pT3a renal tumor staging, we undertook a systematic review and quantitative synthesis to determine whether pT3a represents a heterogeneous histological group and evaluate the oncological outcomes for different pT3a renal tumor invasion patterns and pathological features
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