Pathologic T3a Renal Cell Carcinoma Research Articles

MP47-17 SINGLE CENTER COMPARISON OF RADIOGRAPHIC AND MORPHOMETRIC CHARACTERISTICS AND OUTCOMES IN T3A PATHOLOGICALLY UPSTAGED AND NON-UPSTAGED RENAL CELL CARCINOMA

You have accessJournal of UrologyCME1 Apr 2023MP47-17 SINGLE CENTER COMPARISON OF RADIOGRAPHIC AND MORPHOMETRIC CHARACTERISTICS AND OUTCOMES IN T3A PATHOLOGICALLY UPSTAGED AND NON-UPSTAGED RENAL CELL CARCINOMA Saeed Ghassemzadeh, Aastha Shah, Dhruv Puri, Luke Wang, Franklin Liu, Sohail Dhanji, Kevin Hakimi, Mimi Nguyen, Ryan Nasseri, Margaret Meagher, Clara Cerrato, Juan Javier-Desloges, and Ithaar Derweesh Saeed GhassemzadehSaeed Ghassemzadeh More articles by this author , Aastha ShahAastha Shah More articles by this author , Dhruv PuriDhruv Puri More articles by this author , Luke WangLuke Wang More articles by this author , Franklin LiuFranklin Liu More articles by this author , Sohail DhanjiSohail Dhanji More articles by this author , Kevin HakimiKevin Hakimi More articles by this author , Mimi NguyenMimi Nguyen More articles by this author , Ryan NasseriRyan Nasseri More articles by this author , Margaret MeagherMargaret Meagher More articles by this author , Clara CerratoClara Cerrato More articles by this author , Juan Javier-DeslogesJuan Javier-Desloges More articles by this author , and Ithaar DerweeshIthaar Derweesh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003293.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A significant portion of patients presenting with Stage 1-2 Renal Cell Carcinoma (RCC) are pathologically upstaged to Stage 3 following surgery. This is due to previously undetected extension into the renal venous system, perirenal or renal sinus fat, or collecting system. Improved detection of potential T3 upstaging may prompt changes in disease management and may impact patient survival. We sought to compare pathologically upstaged and non-upstaged T3a RCC cases to identify characteristics of upstaged masses, predictors of T3a disease, and impact on oncological outcomes. METHODS: We conducted a single center retrospective analysis of patients with pathologic T3a RCC who underwent surgical intervention. The cohort was divided into a group of patients with masses which were upstaged, (cT1-cT2/pT3a) and a group with masses preoperatively identified as cT3a (non-upstaged, cT3a/pT3a) for descriptive and outcomes analyses. We sought to delineate proportion of underdiagnosed pT3a RCC, location of upstaged disease, and predictors of upstaging. Outcomes were overall survival (OS) and recurrence-free survival (RFS). Multivariate analyses (MVA) were performed to identify predictors of T3a invasion site and outcomes. Kaplan Meier survival analyses (KMA) were performed to compare survival outcomes. RESULTS: We analyzed 185 patients, of which 120 (64.9%) were upstaged and 65 (35.1%) were non-upstaged. When compared to non-upstaged masses, upstaged masses were significant for smaller size (6.8 cm vs 8.2 cm, p=0.008), lower RENAL score (8.7 vs 9.9, p<0.001), less hilar involvement (29.2% vs 86.2%, p<0.001), and increased exophyticity (41.7% vs 23.1%, p=0.011). On pathology, upstaged masses had greater proportions of perirenal fat invasion (53.3% vs 33.8%, p=0.011), but less venous system (44.2% vs 78.5%, p<0.001) and sinus fat invasion (35.8% vs 63.1%, p<0.001) compared to non-upstaged masses. RENAL domains R, E, and L were independent predictors for T3a disease foci (OR=0.053-7.70, p=0.001-0.042). MVA demonstrated that non upstaged cT3a RCC had a higher risk of recurrence (HR=2.01, p=0.043). KMA noted better RFS in upstaged patients compared to non-upstaged patients (80.8% vs 75.4%, p=0.002). CONCLUSIONS: Pathologically upstaged T3a RCC is associated with distinct morphology and invasion patterns, and improved recurrence free survival when compared to non-upstaged T3a RCC. RENAL domains can aid in identifying masses with upstaging potential. Source of Funding: UC San Diego Summer Research Fellowship © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e651 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Saeed Ghassemzadeh More articles by this author Aastha Shah More articles by this author Dhruv Puri More articles by this author Luke Wang More articles by this author Franklin Liu More articles by this author Sohail Dhanji More articles by this author Kevin Hakimi More articles by this author Mimi Nguyen More articles by this author Ryan Nasseri More articles by this author Margaret Meagher More articles by this author Clara Cerrato More articles by this author Juan Javier-Desloges More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement PDF downloadLoading ...

Tumor Size Significantly Affects Prognosis in Pathological T3a Renal Cell Carcinoma.

To evaluate the prognostic value of tumor size in patients with pathological T3aN0M0 renal cell carcinoma (RCC) postoperatively. We retrospectively reviewed charts of patients with pathological T2N0M0 and T3aN0M0 RCC undergoing radical or partial nephrectomy at our Institution from 2000-2020. Survival analysis using Kaplan-Meier analysis and multivariate Cox regression was performed. A total of 165 patients were included and analyzed. We found that patients with pT3a RCC >7 cm experienced worse 5-year recurrence-free survival (43.8% versus 77.3%, p=0.006) and cancer-specific survival (67.6 versus 94%, p=0.003) compared with those with pT3a RCC ≤7 cm. However, there was no significant difference in recurrence-free and cancer-specific survival between patients with pT2 and pT3a RCC ≤7 cm. Based on multivariate analysis, tumor size >7 cm was an independent factor for tumor recurrence and cancer-related death [hazard ratio(HR)=2.654, p=0.005; and HR=5.016, p=0.005, respectively]. Renal vein invasion was associated with poorer 5-year recurrence-free survival than fat invasion (48.1% versus 70.9%, p=0.032) and was a predictor for tumor recurrence (HR=1.987, p=0.043). Tumor size has a significant impact on prognosis for patients with pathological T3aN0M0 RCC and should be taken into consideration when staging disease and predicting outcomes for these patients.

Partial nephrectomy provides equivalent oncologic outcomes and better renal function preservation than radical nephrectomy for pathological T3a renal cell carcinoma: A meta-analysis.

ABSTRACTPurpose:Radical nephrectomy (RN) is the standard surgical type for pathological stage T3a (pT3a) renal cell carcinoma (RCC). Recently, some studies have suggested equivalence between partial nephrectomy (PN) and RN for oncologic control and have shown the benefits of PN for better renal function. We conducted this meta-analysis to assess oncologic outcomes, perioperative outcomes and renal function between two groups among patients with pT3a RCC.Materials and methods:PubMed, Scopus, Web of Science, Science Direct, Ovid MEDLINE, The Cochrane Library, Embase and Google Scholar were searched for eligible articles. The endpoints of the final analysis included overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS), surgical complications, operative time, estimated blood loss (EBL), serum creatinine and estimated glomerular filtration rate (eGFR).Results:Twelve studies of moderate to high quality, including 14.152 patients, were examined. PN showed superiority for renal functional preservation, providing higher eGFR (WMD=12.48mL/min; 95%CI: 10.28 to 14.67; P <0.00001) and lower serum creatinine (WMD=-0.31mg/dL; 95%CI: −0.40 to −0.21; P <0.00001). There were no significant differences between PN and RN regarding operative time, EBL, surgical complications, OS, RFS and CSS. Despite inherent selection bias, most pooled estimates were consistent in sensitivity analysis and subgroup analysis. More positive margins were found in the PN group (RR=2.42; 95%CI: 1.25-4.68; P=0.009).Conclusions:PN may be more suitable for treating pT3a RCC than RN because it provides a similar survival time (OS or RFS) and superior renal function. Nevertheless, this result is still disputed, and more high-quality studies are required.

PT163 - Multicenter comparison of outcomes for clinical and pathologic T3a renal cell carcinoma

PT163 - Multicenter comparison of outcomes for clinical and pathologic T3a renal cell carcinoma

Multicenter comparison of outcomes for clinical and pathologic T3a renal cell carcinoma.

758 Background: The identification of venous thrombus in patients with renal cell carcinoma (RCC) is particularly challenging, with a substantial number upstaged to pathologic T3a following intervention. We compared survival outcomes between patients with initial cT3a status versus those upstaged to pT3a. Methods: This is a retrospective, multicenter analysis of patients with cT3a or pT3a RCC who underwent operative management. Primary outcome was recurrence-free survival (RFS). Secondary outcomes were overall survival (OS) and cancer-specific survival (CSS). Cox regression multivariable analysis (MVA) was utilized for primary outcome. Kaplan-Meier analyses (KMA) were conducted to describe RFS, OS, and CSS with log-rank test comparing clinical and upstaged pathologic T3a groups. Results: 770 patients were analyzed (cT3a 184, pT3a 586, median follow-up 28 months). Average pathologic tumor size was smaller in pT3a (7.2 cm vs 8.7 cm, p &lt; 0.01), with no significant differences in clinical variables. A similar proportion underwent radical nephrectomy (vs. partial) (89.7% cT3a and 85.0% pT3a, p = 0.11) with no significant different in positive margin rate (3.8% cT3a, 4.8% pT3a, p = 0.23). However, a higher proportion of patients with cT3a disease were pathologically node positive (19.0% vs. 10.8%, p &lt; 0.01) and demonstrated a higher rate of recurrence (cT3a 51.1% vs. pT3a 34.1%, p &lt; 0.01) despite shorter mean follow-up (cT3a 33.0 vs. pT3a 50.7 mo, p &lt; 0.01). MVA for RFS revealed cT3a staging (pT3a referent, HR 1.72, p &lt; 0.01), positive margins (HR 2.85, p &lt; 0.01), and clear cell histology (HR 1.68, p &lt; 0.01) to be independently associated with higher recurrence rate, while partial nephrectomy (radical referent, HR 0.259, p &lt; 0.01) was associated with a decreased rate. KMA revealed 5-year RFS of 34.4% and 60.6% for cT3a and pT3a respectively (p &lt; 0.01). KMA for secondary outcomes revealed 5-year OS rates of 56.7% and 62.0% (p = 0.02) and 5-year CSS of 74.4% and 67.7% for cT3a and pT3a respectively (p = 0.01). Conclusions: Patients with cT3a RCC have poorer oncologic outcomes than those with upstaged pT3a RCC. Suspected venous involvement on pre-operative imaging may indicate more aggressive or advanced disease than that found during surgery.

Impact of tumor size on patient survival after radical nephrectomy for pathological T3a renal cell carcinoma.

We recently reported the results from a multi-institutional retrospective outcome study involving 814 patients with renal cell carcinomas (RCCs) who had undergone radical surgery and whose diagnoses were confirmed via a central pathological review. This study aimed to clarify the impact of tumor size on survival outcomes in patients with pT3aN0M0 RCC after radical nephrectomy using this cohort. Using the Kaplan-Meier method, overall survival (OS), cancer-specific survival (CSS) and relapse-free survival (RFS) were estimated for 103 pT3aN0M0 patients. The differences in the OS, CSS and RFS according to tumor size were evaluated using the log-rank test. To identify independent prognostic factors that affected each survival outcome, clinicopathological factors were examined using univariate and multivariate analyses, and the Cox proportional hazards model. The OS, CSS and RFS rates for 26 patients with pT3a RCCs ≤4 cm were significantly better than those for 77 patients with pT3a RCCs that were 4-7 cm or >7 cm (P = 0.0064, 0.0169 and 0.0001, respectively). Tumor size and venous invasion were independent prognosticators for OS, CSS and RFS. The OS and CSS for patients with pT3a tumors ≤4 cm were comparable with those for patients with pT1 RCCs, and the RFS for patients with pT3a RCCs ≤4 cm was similar to that for patients with pT1b RCCs. Tumor size significantly influenced the prognosis for patients with pT3aN0M0 RCC. This study's results suggest that the postoperative management of pT3a RCCs could be individualized according to tumor size.

Accurate Risk Assessment of Patients with Pathologic T3aN0M0 Renal Cell Carcinoma

To develop a more precise risk-stratification system by investigating the prognostic impact of tumor growth within fatty tissues surrounding the kidney and/or renal vein. We conducted a retrospective review of the medical records of 211 patients with a pathologic diagnosis of T3aN0M0RCC among 4,483 renal cell carcinoma (RCC) patients from February 1988 to December 2015 according to the number of T3a pathologies—extrarenal fat invasion (EFI) and/or renal venous invasion (RVI). During a mean follow-up duration of 38.8 months, the patients with both pathologies (EFI + RVI) had lower recurrence free survival (RFS) rate than those with only a single pathology (p = 0.001). Using multivariable Cox regression analysis, the presence of both factors was shown to be an independent predictor of RFS (HR = 1.964, p = 0.032); cancer specific survival rate was not different among patients with EFI and/or RVI. Patients with pathologic T3aN0M0 RCC presenting with both EFI and RVI were at an increased risk of recurrence following nephrectomy. Therefore, pathologic T3a RCC could be sub-divided into those with favorable and unfavorable disease according to presence of EFI and/or RVI pathologies.

PD12-06 ONCOLOGIC OUTCOMES PERINEPHRIC VERSUS SINUS FAT INVASION IN PATHOLOGIC T3A RENAL CELL CARCINOMA

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy II1 Apr 2018PD12-06 ONCOLOGIC OUTCOMES PERINEPHRIC VERSUS SINUS FAT INVASION IN PATHOLOGIC T3A RENAL CELL CARCINOMA Jeman Ryu, Se Young Choi, Jaehoon Lee, Wonchul Lee, Han Kyu Chae, Wonseok Choi, Bumjin Lim, Jae Hyeon Han, Teak Jun Shin, Yoon Soo Kyung, Sungchan Park, Kyung Hyun Moon, Dalsan You, In Gab Jeong, Jun Hyuk Hong, Hanjong Ahn, and Choung-Soo Kim Jeman RyuJeman Ryu More articles by this author , Se Young ChoiSe Young Choi More articles by this author , Jaehoon LeeJaehoon Lee More articles by this author , Wonchul LeeWonchul Lee More articles by this author , Han Kyu ChaeHan Kyu Chae More articles by this author , Wonseok ChoiWonseok Choi More articles by this author , Bumjin LimBumjin Lim More articles by this author , Jae Hyeon HanJae Hyeon Han More articles by this author , Teak Jun ShinTeak Jun Shin More articles by this author , Yoon Soo KyungYoon Soo Kyung More articles by this author , Sungchan ParkSungchan Park More articles by this author , Kyung Hyun MoonKyung Hyun Moon More articles by this author , Dalsan YouDalsan You More articles by this author , In Gab JeongIn Gab Jeong More articles by this author , Jun Hyuk HongJun Hyuk Hong More articles by this author , Hanjong AhnHanjong Ahn More articles by this author , and Choung-Soo KimChoung-Soo Kim More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.642AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We investigated the influence of perinephric fat invasion (PFI) and sinus fat invasion (SFI) on the oncologic outcomes after radical nephrectomy (RN) or partial nephrectomy (PN) for pathologic T3a renal cell carcinoma (RCC). METHODS Among 3192 patients who underwent RN or PN in our institution between 1998 and 2012, 390 patients were diagnosed with pathologic T3a RCC. Of this cohort, we excluded nodal or distant metastatic RCC, RCC with renal vein thrombosis, and RCC with perinephric and sinus fat invasion. Finally, 107 patients of PFI group and 58 patients of SFI group were included in this study. All patients underwent RN or PN. We compared the clinico-pathological characteristics and oncological outcomes between two groups, and factors predicting disease progression or survival were assessed. RESULTS There were no significant differences in age, gender, the American Society of Anesthesiologists (ASA) status classification, and preoperative estimated glomerular filtration rate (GFR) between two groups. The proportion of patients who underwent RN was significantly higher in the SFI group than PFI group (91.4% vs. 72.9%, p=0.005). Mean maximal tumor diameter in the patients of SFI group was also longer than PFI group (6.5cm vs. 5.9cm, p=0.013). Tumor laterality, Fuhrman grade, histology, and presence of lymphovascular invasion were not significantly different between two groups. In Kaplan-Meier analysis, there was no significantly difference in 3-year disease progression-1free survival (PFS; 83.0% vs. 75.3%, p=0.643), 3-year cancer-specific survival (CSS; 85.6% vs. 93.1%, p=0.373), and 3-year overall survival (OS; 82.7% vs. 89.9%, p=0.658) between PFI and SFI group. In multivariate analysis, longer maximal tumor diameter was an independent predicting factor of shorter PFS (HR: 1.17, p=0.006) and CSS (HR: 1.19, p=0.033). The predictors of shorter OS were older age (HR: 1.03, p=0.022) and longer maximal tumor diameter (HR: 1.13, p=0.021). CONCLUSIONS Sinus fat invasion compared to perinephric fat invasion was not associated with an increased risk of disease recurrence, cancer-specific death, or overall death. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e241 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Jeman Ryu More articles by this author Se Young Choi More articles by this author Jaehoon Lee More articles by this author Wonchul Lee More articles by this author Han Kyu Chae More articles by this author Wonseok Choi More articles by this author Bumjin Lim More articles by this author Jae Hyeon Han More articles by this author Teak Jun Shin More articles by this author Yoon Soo Kyung More articles by this author Sungchan Park More articles by this author Kyung Hyun Moon More articles by this author Dalsan You More articles by this author In Gab Jeong More articles by this author Jun Hyuk Hong More articles by this author Hanjong Ahn More articles by this author Choung-Soo Kim More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Accurate risk assessment of patients with localized pathologic T3a renal cell carcinoma

Accurate risk assessment of patients with localized pathologic T3a renal cell carcinoma

Renal cell carcinoma with perirenal fat invasion: Is partial nephrectomy as good as radical surgery?

e16056 Background: Partial nephrectomy (PN) is the standard of care in the management of cT1a tumors, while radical nephrectomy (RN) is indicated in more advanced tumors. Recent studies provided evidence that PN could be performed in patients with tumors greater that 7 cm with complication rates and oncological outcomes comparable with those undergoing RN. This study compares the recurrence-free survival (RFS), overall (OS) and cancer-specific survival (CSS) of PN and RN in patients with non-metastatic pathological T3a renal cell carcinoma (RCC) with perirenal fat invasion only. Methods: We reviewed 1202 patients undergoing RN (n = 653) and PN (n = 549), at a oncological referral center, from January 2003 to June 2016. Of all patients, we identified 25 RN and 41 PN pT3a tumors with exclusively perirenal fat invasion. None had nodal or distant metastasis at pretreatment clinical staging. Patients characteristics were compared with Mann-Whitney U test and Student t-test for categorical and numeric variables with normal distribution, respectively. Both groups were compared for RFS, OS and CSS with a Kaplan-Meier survival analysis. Results: All patients included had pT3a stage with isolated perirenal fat invasion. Groups undergoing RN and PN were not significantly different regarding Charlson Comorbidity Index (Median 3 for RN vs 4 for PN, p = 0.24) or Age (Mean 65.3 for RN vs 62.0 for PN, p = 0.99). Patients undergoing RN had bigger tumors (7.9 cm vs 4.6, p &lt; 0.001) and higher Fuhrman grade (p = 0.01). Median follow-up was 36 months for RN and 34 months for PN. At the end of follow-up, recurrence was seen in 3 patients undergoing RN (12%) and 2 undergoing PN (5%), p = 0.36. Mortality was similar across groups (16% for RN vs 15% for PN, p = 0.99) as well as Cancer-specific mortality (4% for RN vs. 5% for PN, p = 0.99). At the end of follow-up, RFS was 80% (20/25) for RN and 82% (34/41) for PN. Conclusions: In our data, renal cell carcinoma with T3 stage due to perirenal fat invasion exclusively had similar outcomes when treated with Radical or Partial Nephrectomy. OS as well as RFS were comparable for both surgical modalities, suggesting that, although RN is currently the gold standard for this staging, PN may provide similar oncologic results.

Pathological Upstaging of Clinical T1 to Pathological T3a Renal Cell Carcinoma: A Multi-institutional Analysis of Short-term Outcomes

To determine the oncological impact of pathological upstaging among patients with clinical T1 (cT1) disease treated by partial nephrectomy or radical nephrectomy. The Canadian Kidney Cancer Information System comprises a prospectively maintained multi-institutional database for patients with renal cell carcinoma. Nonmetastatic, cT1 renal cell carcinoma cases were evaluated. Upstaging was defined as pathological T3a disease. Multivariate Cox regression analysis identified predictors for recurrence (local recurrence and/or metastatic disease) whereas logistic regression identified predictors of pathological upstaging. Kaplan-Meier methods estimated survival. Of 1448 eligible cT1 patients, upstaging was observed in 134 (9%). One thousand fifty-eight (73%) were treated by partial nephrectomy. After a median follow-up of 23 months, the 3-year recurrence-free survival was 76% in upstaged patients compared with 93% in those not upstaged (P < .001). Controlling for age, gender, year of surgery, histology, tumor size, surgical approach, and margin status, pathological upstaging was independently associated with disease recurrence (hazard ratio 2.03, 95% confidence interval [CI] 1.12-3.68). Increasing age (odds ratio [OR] 1.02, 95% CI 1.00-1.05), Fuhrman grade (OR 2.47, 95% CI 1.47-4.14), and tumor size (OR 1.16, 95% CI 1.00-1.36) were independently associated with a risk of pathological upstaging. Pathological upstaging confers a negative prognosis and highlights the importance of accurate clinical staging. A number of factors have been identified, including some attainable by renal biopsy, which may predict upstaging and provide valuable adjunct information to inform risk stratification and management decisions among patients with cT1 renal masses.

722 The prognostic impact of tumour size on cancer-specific and overall survival among patients with pathologic t3a renal cell carcinoma

722 The prognostic impact of tumour size on cancer-specific and overall survival among patients with pathologic t3a renal cell carcinoma

The Prognostic Impact of Tumor Size on Cancer-Specific and Overall Survival Among Patients With Pathologic T3a Renal Cell Carcinoma

BackgroundWe aimed to determine the prognostic role of tumor size in patients with stage pT3a renal cell carcinoma (RCC). Patients and MethodsWe analyzed our database of patients who underwent radical nephrectomy for RCC between July 2000 and December 2013. Clinical and pathologic data were obtained for each patient. Patients with stage pT3a disease were divided into 2 subgroups according to the most informative threshold for pathologic tumor dimension that was able to predict survival outcomes (group 1, ≤ 8 cm; group 2, > 8 cm). ResultsGlobally, 185 consecutive patients were evaluated. The median (interquartile range [IQR]) follow-up was 32 months (18-62 months). The median (IQR) pathologic tumor size was 7.5 cm (5.7-10 cm). Seventy (34.3%) patients died of RCC during the follow-up period. Patients in group 2 experienced worse cancer-specific survival (CSS) rates compared with those in group 1, (5- and 10- year CSS, 52% and 40% vs. 67% and 63%, respectively; P = .001). Overall survival (OS) rates were significantly lower for patients included in group 2 compared with patients in group 1 (5- and 10- year OS rates, 46% and 38% vs. 60% and 57%, respectively; P = .01). Subgroup stratification (hazard ratio [HR], 3.65; P < .001), presence of positive surgical margins (HR, 3.86; P = .22), high Fuhrman grade (HR, 4.33; P < .001), and the presence of sarcomatoid cells (HR, 2.61; P = .02) were found to be independent predictors of CSS. ConclusionWorse oncologic outcomes are observed in patients with stage pT3a RCC tumors > 8 cm. The current TNM classification still does not precisely correlate with CSS. Tumor size should be taken into account in a future revision of the TNM staging system.

Editorial Comment to Partial nephrectomy versus radical nephrectomy for non-metastatic pathological T3a renal cell carcinoma: A multi-institutional comparative analysis

Editorial Comment to Partial nephrectomy versus radical nephrectomy for non-metastatic pathological T3a renal cell carcinoma: A multi-institutional comparative analysis

Partial nephrectomy versus radical nephrectomy for non‐metastatic pathological T3a renal cell carcinoma: A multi‐institutional comparative analysis

To compare the recurrence-free survival of partial nephrectomy and radical nephrectomy in patients with non-metastatic pathological T3a renal cell carcinoma. We reviewed the records of 3567 patients who had undergone a nephrectomy for renal cell carcinoma at five institutions in Korea from January 2000 to December 2010. The clinical data of 45 patients with pathological T3a renal cell carcinoma in the partial nephrectomy group were compared with 298 patients with pathological T3a renal cell carcinoma in the radical nephrectomy group. The effects of surgical methods on recurrence-free survival were assessed by a multivariate Cox proportional hazard analysis. All comparisons were repeated in subgroup analysis on 63 clinical T1a patients with tumors ≤4 cm. During a median 43-month follow-up period, disease recurrence occurred in two patients (4.4%) in the partial nephrectomy group, and 94 patients (31.5%) in the radical nephrectomy group. The results from a multivariate model showed that radical nephrectomy was a significant predictor of recurrence. However, in subgroup analysis that included 63 clinical T1a pathological T3a patients, the recurrence-free survival rates were not significantly different between the two cohorts. The renal function was significantly better preserved in the partial nephrectomy cohort than in the radical nephrectomy cohort. Partial nephrectomy provides similar recurrence-free survival outcomes compared with radical nephrectomy in patients with clinical T1a pathological T3a renal cell carcinoma. However, there seems to be a higher risk of recurrence for large pathological T3a tumors treated by radical nephrectomy compared with small tumors treated by partial nephrectomy. Thus, large tumors with the same pathological T3a renal cell carcinoma grade could have hidden aggressive features.

Differing Risk of Cancer Death Among Patients With Pathologic T3a Renal Cell Carcinoma: Identification of Risk Categories According to Fat Infiltration and Renal Vein Thrombosis

ObjectivesThe study objectives were to evaluate the prognostic impact of fat infiltration and renal vein thrombosis in patients with pT3a renal cell carcinoma (RCC) and to identify new prognostic groups. Material and MethodsWe analyzed 122 consecutive patients with pT3a who underwent radical nephrectomy for RCC between 2000 and 2011 at the University of Bologna. Cancer-specific survival (CSS) rates were estimated using Kaplan–Meier survival curves; univariable and multivariable analyses were performed with Cox analysis. ResultsThe mean follow-up was 41.7 ± 35.4 months. Patients with peritumoral/hilar fat infiltration (n = 63) and patients with renal vein thrombosis (n = 18) experienced comparable CSS rates, whereas patients with both fat infiltration plus renal vein thrombosis (n = 41) showed worse survival outcomes than the first group (P = .026). Patients were divided in 2 groups: group A, with fat invasion or renal vein thrombosis, and group B, with concomitant fat invasion and renal vein invasion. Group B showed worse cancer-specific survival than group A (P = .024). At multivariate analysis, this new risk-group stratification was found to be an independent prognostic predictor of CSS (P < .05). ConclusionsPatients with T3a RCC with both fat invasion and renal vein thrombosis experience worse survival rates when compared with those patients with only 1 prognostic factor. The TNM classification should consider the concomitant presence of those parameters as a different prognostic predictor.