Abstract
BackgroundThe prognosis of patients with pathologic stage T3a renal cell carcinoma (RCC) that is up-staged from a small renal tumor remains controversial. We evaluated the prognosis of patients with RCC who were up-staged from clinical stage T1 to pathologic stage T3a.MethodsWe retrospectively reviewed the data of 3431 patients who were surgically treated for clinical stage T1 RCC. The survival outcomes were compared using Kaplan-Meier and Cox proportional analyses.ResultsAmong the clinical stage T1 patients, 215 (6.3%) were finally up-staged to pathologic stage T3a. Patient age (HR 1.302, 95% CI 1.018–1.046, p < 0.001), tumor diameter (HR 1.686, 95% CI 1.551–1.834, p < 0.001), and hilar location (HR 1.765, 95% CI 1.147–2.715, p = 0.010) were significantly associated with upstaging. Kaplan-Meier analyses showed significantly shorter recurrence-free, cancer-specific and overall survivals (all p < 0.001) in patients who were up-staged. Multivariate Cox analyses revealed pathologic upstaging as an independent predictor of shorter recurrence-free (HR 2.195, 95% CI 1.459–3.300, p < 0.001), cancer-specific (HR 2.238, 95% CI 1.252–4.003, p = 0.007), and overall survivals (HR 1.632, 95% CI 1.029–2.588, p = 0.037). Subgroup analysis of pathologic stage T3a showed no significant difference in survival of the partial nephrectomy group when compared to the radical nephrectomy group (all p > 0.5).ConclusionsPatients up-staged from clinical stage T1 to pathologic stage T3a RCC showed shorter survival outcomes than those without upstaging. However, partial nephrectomy, compared with radical nephrectomy, showed comparable outcomes in patients who were up-staged.
Highlights
The prognosis of patients with pathologic stage T3a renal cell carcinoma (RCC) that is up-staged from a small renal tumor remains controversial
We tried to evaluate the oncological outcomes and exact prognosis of patients with clinical stage T1 RCC in our cohort whose cancers were upstaged from clinical stage T1 to pathologic stage T3a after surgery using the recent definitions of the 2010 TNM classification
After approval from the Institutional Ethical Review Board, we retrospectively reviewed the medical records of 3749 patients who underwent surgery between January 1997 and December 2016 for clinical stage T1 renal tumors and who were diagnosed with RCC without any evidence of metastasis
Summary
The prognosis of patients with pathologic stage T3a renal cell carcinoma (RCC) that is up-staged from a small renal tumor remains controversial. Previous studies have reported heterogeneous oncological outcomes between patients who experienced pathologic upstaging (clinical stage T1 to pathologic stage T3a) and those who did not [8,9,10,11]. Some reported similar survival outcomes between the two groups, while others showed contradictory results Another important issue in this regard is the lack of unified application of the recent TNM classification. We tried to evaluate the oncological outcomes and exact prognosis of patients with clinical stage T1 RCC in our cohort whose cancers were upstaged from clinical stage T1 to pathologic stage T3a after surgery using the recent definitions of the 2010 TNM classification
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