Abstract
We aimed to determine the oncological outcomes of patients with clinical T1 renal cell carcinoma (RCC) upstaged to pathological T3a and to identify the preoperative predictive factors for upstaging. We retrospectively reviewed 272 patients with clinical T1 RCC who underwent surgical treatment. Thirty-three patients (12%) were upstaged to pathological T3a. These patients had a significantly larger tumor size on computed tomography (p < 0.0001), a higher aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (p = 0.037), and an elevated c-reactive protein (CRP) level (p = 0.014) preoperatively compared with those with pathological T1 RCC. On multivariate analysis, tumor diameter was the only significant preoperative predictive factor for upstaging [hazard ratio (HR), 3.61; 95% confidence interval (CI), 1.32–9.84; p = 0.01]. The AST/ALT ratio tended to be a preoperative predictive factor for upstaging, although it was not significant (HR, 2.14; 95% CI, 0.97–4.73; p = 0.06). Pathological T3a upstaging occurred in 25% of those with a tumor diameter ≥30 mm and a preoperative AST/ALT ratio ≥1.1. There was a significant correlation between pathological T3a upstaging and the number of preoperative risk factors (p = 0.0002). The preoperative tumor diameter and serum AST/ALT ratio can be predictive factors for pathological T3a upstaging in patients with clinical T1 RCC.
Highlights
Clinical staging is essential for treatment decision-making in patients with renal cell carcinoma (RCC)
The selection of the surgical technique often depends on the clinical T stage of the tumor; T1 and T2 tumors are classified according to the tumor size, whereas T3a tumors are defined based on the presence of peripheral fat invasion, renal sinus fat infiltration, or renal vein extension, regardless of the tumor size
Microscopic perirenal invasion, renal sinus fat infiltration, and renal vein extension can be missed during contrast-enhanced computed tomography (CT) imaging, occasionally leading to the pathological upstaging of a clinical T1 tumor to pathological
Summary
Clinical staging is essential for treatment decision-making in patients with renal cell carcinoma (RCC). The selection of the surgical technique (partial or radical nephrectomy) often depends on the clinical T stage of the tumor; T1 and T2 tumors are classified according to the tumor size, whereas T3a tumors are defined based on the presence of peripheral fat invasion, renal sinus fat infiltration, or renal vein extension, regardless of the tumor size. Microscopic perirenal invasion, renal sinus fat infiltration, and renal vein extension can be missed during contrast-enhanced computed tomography (CT) imaging, occasionally leading to the pathological upstaging of a clinical T1 tumor to pathological. This study investigates the oncological outcomes of pathological T3a upstaging and identifies the preoperative predictive factors for upstaging in patients with cT1 RCC Several previous studies have reported a poor prognosis of patients with RCC with cT1 tumors upstaged to pT3a when compared with a prognosis of patients with pathological T1 tumors [1,2,3,4].
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