Abstract
PurposeThe 7th TNM classification summarizes renal cell carcinoma (RCC) with perirenal (PFI) and/or sinus fat invasion (SFI) as well as hilar vein involvement (RVI) as pT3a tumors. In this study, we aimed to determine the prognostic value of fat invasion (FI) in the different compartments and RVI for medium-term cancer-specific-survival (CSS) in pT3a RCC.Materials and methodsPatients with pT3a RCC were identified using an institutional database. All original pathological reports were reclassified according to the 7th TNM edition. The prognostic value of FI as well as divided into PFI, SFI, combined PFI + SFI, and RVI for CSS was assessed using univariate and multivariate Cox-regression analysis. Survival was estimated using the Kaplan–Meier method.ResultsMedian follow-up in 184 pT3a tumors was 38 months. FI was detectable in 153 patients (32.7% PFI, 45.1% SFI, 22.2% PFI + SFI), 31 patients showed RVI alone. Combined PFI + SFI increased the risk of cancer-related death compared to PFI (HR 3.11, p < 0.01), SFI (HR 1.84, p = 0.023) or sole RVI (HR 2.12, p = 0.025). In multivariate analysis, a combined PFI + SFI vs. PFI or SFI as the only compartment involved was confirmed as independent prognostic factor (HR 1.83, p = 0.029). Patients with FI and simultaneous RVI had significantly shorter CSS (HR 2.63, p < 0.01). In an unweighted model, the difference between patients with combined PFI + SFI and RVI and those with PFI alone was highest (HR 4.01, p = 0.029).ConclusionsThese results underline the subdivision of pT3a RCC depending on the location of FI and RVI for patient stratification.
Highlights
Overall survival of patients with renal cell carcinoma (RCC) varies widely
We examined the prognostic value of fat invasion (FI), divided in PFI, sinus fat invasion (SFI), and combined PFI + SFI, and RVI for medium-term cancer-specific survival (CSS) in patients with pT3a RCC to improve risk stratification
We retrospectively examined the prognostic value of FI and depending on the different fat compartments as well as RVI for medium-term CSS using 184 non-metastatic and metastatic RCC patients from an intern register
Summary
The likelihood for patients with localized RCC treated in curative intention with tumor resection to suffer relapse with lymph node or distant metastases is up to 30% [1]. Tumor invasion in the renal fat is often divided into perirenal (PFI) and perihilar (SFI) fat invasion and is detected in 5.1–18.5% of cases [2, 3]. Up to this time, tumors with invasion of the perinephric tissue or the adrenal gland were classified as pT3a tumors, and those with expansion into the hilar veins, their segmental branches or the vena cava below the diaphragm as pT3b tumors. Due to the revision of the TNM classification in 2010, tumors with FI and even extension into the hilar veins or their segmental (muscle-containing) branches are summarized as pT3a tumors. The prognostic value of FI with subdivision in the different fat compartments PFI and SFI with or without hilar vein involvement (RVI) is controversially discussed
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