Sinus Fat Invasion Research Articles

To stage or not to stage: determining the true clinical significance of the biopsy tract through perinephric fat in assessing renal cell carcinoma.

Perinephric fat invasion (PFI) is a key component of renal cell carcinoma (RCC) staging, but there are limited data pertaining to biopsy tract seeding (BTS) resulting in perirenal tissue involvement [BTS with perinephric fat invasion (BTS-P)].The aim is to correlate clinical outcomes with pathologic stage to determine whether the presence of BTS-P should be considered a criterion to stage RCC as part of the pT3a category in the absence of any other upstaging variables. We identified 304 renal biopsies from patients with subsequent nephrectomies for RCC; 33 of the tumours contained PFI. Each case was reviewed to determine the presence of BTS-P and other forms of invasion [e.g. non-BTS-P PFI, sinus fat invasion (SFI), and/or renal vein invasion (RVI)], and these findings were compared with survival outcomes. Ten (30%) of 33 tumours with PFI showed BTS-P as the only finding, and were otherwise pT1 tumours; six (60%) patients were alive without disease (AWOD) (mean, 77.5months), three were lost to follow-up (LTF), and one died of other disease (DOOD). Two patients showed true PFI plus BTS-P; one was LTF and one is AWOD at 107months. Ten (43%) of 23 patients with tumours with true invasion (PFI±SFI and/or RVI) are AWOD (mean, 97.7months), eight (35%) died of disease (DOD), four were LTF, and one DOOD. Kaplan-Meier survival curves showed that the cancer-specific survival was significantly worse in patients with true invasion (P=0.044) than in those with BTS-P as the sole finding. Patients with tumours showing BTS-P only appear to have better outcomes than those with other non-PFI invasion, suggesting that this finding should not be upstaged to pT3a. Additional studies are needed to corroborate the significance of our observations.

Diagnostic value of MDCT in determining the perinephric fat tissue and renal sinus invasion in patients with clear cell renal cell carcinoma.

To investigate the accuracy of multidetector computed tomography (MDCT) findings, and the effect of tumor volume in determining the perinephric and renal sinus invasion in clear cell renal cell carcinomas (ccRCCs). Fifty patients with ccRCCs underwent non-contrast and nephrographic-phase contrast-enhanced MDCT examination before total nephrectomy. The following MDCT features were used to diagnose perinephric fat tissue invasion: perinephric stranding, perinephric vascularity, and irregular contour. The following MDCT features were used to diagnose renal sinus fat invasion: elongation of tumor into renal sinus, invasion, or compression of pelvicalyceal system. Histopathologic examinations were used as a gold standard. Fourteen out of 50 ccRCCs patients (28%) had histopathological-proven perinephric fat tissue invasion. The sensitivity, specificity, PPV, NPV, and accuracy of MDCT in the detection of perinephric fat tissue invasion were found 64%, 58%, 38%, 80%, and 60%, respectively. Seven out of 50 ccRCCs patient (14%) had histopathological-proven renal sinus invasion. The sensitivity, specificity, PPV, NPV, and accuracy of MDCT in the detection of renal sinus invasion were found 85%, 65%, 28%, 96%, and 68%, respectively. The area under of curve (AUC) value of tumor volume in the detection of perinephric fat invasion was 0.631. The AUC value of tumor volume in the detection of renal sinus invasion was 0.803. MDCT has a good sensitivity for detection of renal sinus fat invasion, but low PPV and specificity in patients with ccRCC. Tumor volume, and invasion into the pelvicalyceal structures can aid in the diagnosis of renal sinus fat invasion preoperatively.

Ferroportin and FBXL5 as Prognostic Markers in Advanced Stage Clear Cell Renal Cell Carcinoma.

PurposeAdvanced stage clear cell renal cell carcinoma (ccRCC) involves a poor prognosis. Several studies have reported that dysfunctions in iron metabolism–related proteins may cause tumor progression and metastasis of this carcinoma. In this study, we investigated the impact of the expression of iron metabolism–related proteins on patient prognoses in advanced stage ccRCCs.Materials and MethodsAll of 143 advanced stage ccRCC specimens were selected following validation with double blind reviews. Several clinicopathological parameters including nuclear grade, perirenal fat invasion, renal sinus fat invasion, vascular invasion, necrosis, and sarcomatoid/rhabdoid differentiation were compared with the expression of ferroportin (FPN), and F-Box and leucine rich repeat protein 5 (FBXL5), by immunohistochemistry. FPN and FBXL5 mRNA level of ccRCC from The Cancer Genome Atlas database were also analyzed for validation.ResultsFPN and FBXL5 immunohistochemistry showed membrane and cytoplasmic expression, respectively. Based on the H-score, cases were classified as low or high expression with a cutoff value of 20 for FPN and 15 for FBXL5, respectively. Low expression of FPN and FBXL5 were significantly associated with patient death (p=0.022 and p=0.005, respectively). In survival analyses, low expression of FPN and FBXL5 were significantly associated with shorter overall survival (p=0.003 and p=0.004, respectively). On multivariate analysis, low expression of FBXL5 (hazard ratio, 2.001; p=0.034) was significantly associated with shorter overall survival.ConclusionFPN and FBXL5 can be used as potential prognostic markers and therapeutic targets for advanced stage ccRCC.

The prognostic value of fat invasion and tumor expansion in the hilar veins in pT3a renal cell carcinoma

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.

Effect of Multidisciplinary Approach in Diagnosis of Renal Sinus Fat Invasion in Renal Cell Cancer

Effect of Multidisciplinary Approach in Diagnosis of Renal Sinus Fat Invasion in Renal Cell Cancer

Clinical Significance of Tumor Size, Pathological Invasion Sites Including Urinary Collecting System and Clinically Detected Renal Vein Thrombus as Predictors for Recurrence in pT3a Localized Renal Cell Carcinoma.

The recent eighth tumor-node-metastasis (TMN) staging system classifies renal cell carcinoma (RCC) with perirenal fat invasion (PFI), renal sinus fat invasion (SFI), or renal vein invasion (RVI) as stage pT3a. However, limited data are available on whether these sites have similar prognostic value or recurrence rate. We investigated the recurrence rate based on tumor size, pathological invasion sites including urinary collecting system invasion (UCSI), and clinically detected renal vein thrombus (cd-RVT) with pT3aN0M0 RCC. We retrospectively reviewed 91 patients with pT3aN0M0 RCC who underwent surgical treatment. Patients with tumor size > 7 cm, UCSI, three invasive sites (PFI + SFI + RVI), and cd-RVT showed a significant correlation with high recurrence rates (hazard ration (HR) 2.98, p = 0.013; HR 8.86, p < 0.0001; HR 14.28, p = 0.0008; and HR 4.08, p = 0.0074, respectively). In the multivariate analysis, tumor size of >7 cm, the presence of UCSI, and cd-RVT were the independent predictors of recurrence (HR 3.39, p = 0.043, HR 7.31, p = 0.01, HR 5.06, p = 0.018, respectively). In pT3a RCC, tumor size (7 cm cut-off), UCSI, and cd-RVT may help to provide an early diagnosis of recurrence.

Improving detection of higher-risk or locally advanced disease features in stage I and II renal cell carcinoma.

625 Background: Pathologically upstaged T3a renal cell carcinoma (RCC) carries higher oncologic risk than corresponding preoperative clinical stage and presents unique risks from a treatment planning standpoint due to reduced clinician awareness of locally aggressive disease. We sought to identify imaging criteria that predict risk of pathological upstaging of clinical T1 and T2 RCC to T3a and to assess accuracy of CT in detecting T3a RCC. Methods: Single institution retrospective analysis of patients who underwent surgery for RCC. A propensity-score matching process was used to match upstaged patients with non-upstaged (control) patients in a 1:2 fashion. Preoperative CT images were reviewed in a blinded fashion by 2 radiologists for presence of T3a stage imaging criteria. Multivariable analyses assessed risk conferred by imaging features and sensitivity analysis assessed accuracy in detecting T3a RCC. Results: After exclusions, 231 patients were analyzed (mean age 61 years, upstaged 83/control 148, mean tumor size 6.4 cm). In 71/83 (86%) of upstaged tumors, the presence of sinus fat invasion (SFI), perinephric fat invasion (PFI), or venous invasion (VI) was found. The presence of all three was not observed in any non-upstaged tumor. The following features were associated with upstaging: tumor necrosis (OR 2.1, p=0.017), irregular tumor edge (OR 2.9, p&lt;0.001), thickened perirenal fascia (OR 2.6, p=0.001), perinephric stranding (OR 1.8, p=0.043), increased perinephric vascularity (OR 2.02, p=0.021), and perinephric nodules (OR 3.4, p=0.020). The SE/SP for tumor necrosis, irregular tumor edge, thickened perirenal fascia, perinephric stranding, increased perinephric vascularity, and perinephric nodules were 42%/74%, 74%/50%, 48%/74%, 70%/44%, 70%/46%, and 13%/96%, respectively. Conclusions: Upstaged T3a RCC contained several preoperative imaging attributes which were 2-3 times more likely to be present than in non-upstaged tumors. Of these, irregular tumor edge had highest sensitivity, and perinephric nodules had highest specificity. These features should elevate clinical suspicion for T3a disease and may be used to develop a novel risk scoring system. Further investigation is requisite.

Prognostic significance of the sub-classification of stage pT3a renal tumors by perinephric and sinus fat invasion.

In the current Tumor-Node-Metastasis (TNM) classification system for renal cell carcinoma (RCC), both perinephric fat invasion (PFI) and renal sinus fat invasion (SFI) are classified at the T3a stage. However, their associated prognoses are clinically controversial. The present study proposes a new sub-classification criterion for pathological T3a (pT3a) RCC with SFI or PFI to resolve this dispute. Data were collected from consecutive records of 2,765 patients with T1a renal cancer, who had undergone partial nephrectomy (PN) between 2001 and 2015 at one of four hospitals. Among these patients, 127 cases were diagnosed with stage pT3a RCC with SFI or PFI, according to final pathological examination. The pathological characteristics, clinical data and follow-up observations were analyzed. Of the 127 patients, with an average follow-up duration of 56 months (range, 15–60 months), 17 cases of tumor recurrence were found. After analysis of the pathological findings, the following new sub-classification criteria was proposed for pT3a RCC with SFI or PFI: i) Type A, renal tumor invades the pseudo-capsule and contacts with the perinephric adipose tissues directly (3 recurrences out of 57 patients); ii) type B, tumor protrudes into the perinephric adipose tissues like a tongue (4 recurrences out of 29 patients); and iii) type C, tumor nodules distribute in perinephric adipose tissues (10 recurrences out of 41 patients). There was statistically significant difference between the three subtypes in terms of recurrence rate (P=0.023). In conclusion, controversies remain in the current TNM classification system for pT3a RCC. The present study added to the available data and found that pT3a RCC with tumor nodules in perinephric adipose or/and with an irregular tumor protruding into adipose tissues showed a higher recurrence rate. Thus, it is recommended that pT3a RCC should be carefully analyzed and should be considered differently to other stages of RCC.

Evaluation of individual and cumulative sites of extrarenal tumor invasion in pT3a clear cell renal cell carcinoma

IntroductionThe Tumor-Node-Metastasis classification of renal cell carcinoma (RCC) for pT3a tumors includes sinus fat invasion (SFI), perinephric fat invasion (PFI), renal vein invasion (RVI), and/or pelvicaliceal system invasion (PSI). The purpose of this study was to determine the association between these patterns of invasion (assessed individually and cumulatively) with the development of metastases and cancer-specific mortality (CSM). Materials and methodsWe identified 160 patients who underwent radical nephrectomy for pT3a clear cell RCC between 2011 and 2017. The association between individual patterns of invasion and metastases and cancer-specific survival were evaluated with multivariate logistic regression. Cox Hazard proportion ratios and Kaplan-Meier survival curves were generated for patterns of invasion (assessed individually and cumulatively). ResultsThe number of individual invasive patterns was as follows: 97/160 (61%) presented with RVI, 91/160 with SFI (57%), 62/160 with PFI (39%), and 24/160 (15%) with PSI. At multivariate analysis, both PFI and RVI were associated with metastases (P < 0.001 and 0.028, respectively). PFI (hazard ratio [HR] 4.12, 95% confidence interval [CI] 2.14–7.92; P < 0.001), RVI (HR 2.44, 95% CI 1.18–5.01; P = 0.015), SFI (HR 2.13, 95% CI 1.05–4.34; P = 0.036) had higher CSM, while PSI (HR 1.43, 95% CI 0.65-3.16; p = 0.38) did not show increased CSM. Furthermore, cumulative analysis showed that multiple invasive patterns resulted in worse CSM (p < 0.001). ConclusionsIn our study, PFI was associated with the most aggressive behavior while PSI was the most indolent. Furthermore, the presence of more than one pattern of invasion was associated with worse CSM. These results indicate that reporting of the individual location and cumulative amount of pT3a patterns of invasion in clear cell RCC is clinically relevant.

Is multidetector CT-scan able to detect T3a renal tumor before surgery?

Objective: To evaluate the diagnostic accuracy of multidetector Computed Tomography (MDCT) in predicting T3a renal cell carcinoma (RCC).Materials and methods: Preoperative MDCT of 96 patients with 100 pathologically proven RCC were assessed by two radiologists focusing on the presence of peritumoral fat, sinus fat or venous invasion for cT3a staging. Nature of tumor margins and the presence of peritumoral neovessels were also evaluated, as the influence of perinephric soft-tissue stranding in the interpretation of peritumoral fat.Results: Sensitivity for the identification of peritumoral fat, sinus fat or renal vein invasion was 77%, 86% and 86%, and specificity was 72%, 88% and 97%, respectively. Sensitivity and specificity in the prediction of T3a tumors were 72% and 70% respectively (κ score = 0.38 (0.29–0.47)). Among the 38 pT3 tumors, 6 (16%) were under-staged, and the neovessels and irregular tumor edge as secondary CT signs did not significantly increase the accuracy of the prediction of local invasion. Among the 62 confined tumors, 17 (27%) were over-staged as cT3 and among these 17 false positives cases, perinephric soft-tissue stranding was present in 14 cases.Conclusion: MDCT provides good results in detecting sinus fat, venous invasion and kidney-confined tumors, but evaluation of perinephric fat remains a difficult task, leading to reduced accuracy in T3a staging.

Perinephric invasion as a prognostic factor in non-metastatic renal cell carcinoma: analysis of a nation-wide registry program.

Perinephric fat invasion (PFI) of renal cell carcinoma (RCC) is known to be associated with adverse pathological features and poor prognosis. We analyzed these associations using a sub-group of the RCC registry of The Cancer Registration Committee of the Japanese Urological Association. The study cohort of 2998 non-metastatic cases was retrieved from RCC registry (3648 in total). We compared clinicopathological characteristics of cases with PFI (n = 256) and without PFI (n = 2742), and investigated the impact of PFI on cancer-specific survival using univariate and multivariate analyses. Compared with non-PFI cases, PFI cases were older (P = 0.003), and more likely to be hypertensive (P = 0.034) and symptomatic at presentation (P < 0.001). PFI tumors were larger (P < 0.001), and more often have sarcomatoid component (P < 0.001) and tumor thrombus (P < 0.001). Cancer-specific survival was significantly shorter in cases with PFI than without (P < 0.001). The difference in survival tended to be greater in cases with large tumors but was significant in small tumor sub-groups. Cancer-specific survival was significantly shorter in cases with both PFI and renal vein involvement (RVI) in comparison to those with PFI or RVI alone (P = 0.011, P = 0.007, respectively). On multivariate analysis PFI with and without sinus fat invasion remained as an independent risk factor along with symptom at presentation, low body mass index, hypertension, multiple tumors, large tumor size (>7.0 cm), sarcomatoid component and RVI. PFI was associated with advanced age and aggressive pathological features. PFI is an independent prognostic factor in non-metastatic RCC.

The prognostic value of the site of invasion in T3aN0M0 clear cell renal cell carcinoma

BackgroundThe 7th Tumor-Node-Metastasis system for clear cell renal cell carcinoma (ccRCC) classified renal sinus fat invasion (SFI), perirenal fat invasion (PFI), or renal vein invasion (RVI) as stage pT3a. However, their close interactions and prognostic value of them remain controversial. The goal of this study is to further analyze their prognostic values for patients with T3aN0M0 ccRCC. MethodsThe data of 1,869 pT3aN0M0 ccRCC patients receiving the radical nephrectomy surgery were collected from the National Cancer Institute Surveillance, Epidemiology, and End Results database of United states from 2010 to 2014. These Patients were grouped as SFI, PFI, SFI + RVI, SFI + PFI, PFI + RVI, and SFI + PFI + RVI according to their corresponding manifestations. Cancer-specific survival (CSS) was determined using the Kaplan–Meier method. Univariate and Multivariate cox proportional-hazards regression methods were used to evaluate the impacts of clinical pathologic parameters on CSS. ResultsPatients with SFI or PFI alone had the similar CSS (P = 0.286) and patients with SFI + PFI + RVI had the worst outcomes. Moreover, significantly more patients with SFI + PFI + RVI had tumor diameter ≥7cm than patients with PFI + RVI, SFI + PFI (68.80% vs. 65.32%, 58.77%, and 55.04%, P = 0.026), respectively. Multivariable analysis showed that RVI + PFI (P = 0.013) and PFI + SFI + RVI (P = 0.011) were the independent factors of CSS. ConclusionsThe results suggest that invasion location can help distinguish patients with T3aN0M0 ccRCC with increased risk of cancer-related mortality.

Clear cell renal cell carcinoma with heterotopic bone formation: A case report and literature review

The phenomenon of heterotopic bone formation (osseous metaplasia) is defined as an abnormal ossification of non-skeletal tissues and does represent a rare occurrence in the renal cell carcinoma setting. We describe a case of a 40-year old man with bilateral renal cell carcinomas of the histological clear cell subtype, with the right-sided renal cell carcinoma demonstrating heterotopic bone formation, as well as the presence of intratumoral adipose tissue. The etiology of bone formation in a renal cell carcinoma is unclear, but possible explanations include a response to tissue ischemia and the expression of Bone Morphogenetic Protein 2. The detection of these rare morphologic variations is of paramount importance, not to be mistaken as sarcomatoid transformation and renal sinus fat invasion, which would advance the pathologic tumor stage and aggressiveness of the disease.

Neutrophil-to-Lymphocyte Ratio Predicts Pathological Renal Sinus Fat Invasion in Renal Cell Carcinomas of ≤7 cm with Presumed Renal Sinus Fat Invasion.

PurposeComputed tomography (CT) is the most useful diagnostic modality for staging renal cell carcinoma (RCC). However, CT is limited in its ability to predict renal sinus fat invasion (SFI). Here, we aimed to evaluate whether preoperative neutrophil-to-lymphocyte ratio (NLR) could predict pathological SFI in patients with RCC of ≤7 cm for whom preoperative imaging reveals potential renal SFI.Materials and MethodsWe reviewed the medical records of 1311 patients who underwent extirpative renal surgery for non-metastatic RCC of ≤7 cm between November 2005 and December 2014. After excluding patients with no SFI in preoperative imaging, unavailable preoperative data, and morbidity affecting inflammatory markers, a total of 476 patients were included in this study. Multivariate logistic regression analysis was used to evaluate predictors of pathological SFI.ResultsWe implemented a cut-off value of 1.98, which was calculated by ROC analysis to obtain high (≥1.98) and low (<1.98) NLR groups. A total of 93 patients with pathological SFI had larger clinical tumor size, higher preoperative NLR, larger pathological tumor size, more frequent renal vein involvement, and higher Fuhrman nuclear grade. Multivariate analysis indicated that high NLR [odds ratio (OR) 2.032, p=0.004], clinical tumor size (OR 1.586, p<0.001), and collecting system involvement on preoperative imaging (OR 3.957, p=0.011) were significantly associated with pathological SFI in these tumors.ConclusionPreoperative high NLR was associated with pathological SFI in patients with RCC of ≤7 cm and presumed SFI on preoperative imaging. Greater surgical attention is needed to obtain negative margins during partial nephrectomy in these patients.

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 ...

Defining individual recurrence risk following surgery for high risk non-metastatic renal cell carcinoma.

664 Background: Current models to estimate renal cell carcinoma (RCC) recurrence risk following surgery are derived from populations containing primarily low-risk patients. The objective of this study was to evaluate risk factors for recurrence among high risk non-metastatic RCC patients following attempted curative surgery. Methods: Data from 3 independent centers was analyzed for consecutive ≥ pT3a RCC patients without evidence of lymph node or distant metastases who were treated surgically from 2000-2016. Univariate and multivariate Cox proportional hazard models were used to evaluate associations of common clinical and pathological variables with recurrence risk. A risk model was constructed using independent predictors and recurrence risk was evaluated using Kaplan-Meier analysis. Results: Of 771 patients, 190 (24.6%) had RCC recurrence following attempted curative surgery at median 10.2 months (IQR 4.4-20.7). Median overall follow-up interval was 21.4 months (IQR 6.6-53.5). After multivariate Cox proportional hazard analysis, significant associations with RCC recurrence were not identified with: age, gender, race, systemic symptoms, local symptoms, pT stage, perinephric fat invasion, tumor thrombus, sinus fat invasion, serum hemoglobin, or serum albumin. Independent predictors included grade 4 HR 3.27 (95% CI 2.17, 4.92); tumor diameter &gt; 7cm HR 1.70 (95% CI 1.18, 2.45), tumor necrosis HR 1.47 (95% CI 1.06, 2.02), and sarcomatoid/ rhabdoid features HR 1.86 (95% CI 1.12, 3.09) An unweighted risk model was created by assigning one point for each independent predictor. Estimated 3-year recurrence risk was 14%, 25%, 40%, 49%, and 69% for patients with 0,1,2,3 and 4 risk factors (p &lt; 0.001) respectively. Conclusions: Independent predictors of recurrence for high risk non-metastatic RCC include: tumor diameter, necrosis, nuclear grade 4, and sarcomatoid/ rhabdoid features. This model may be used to estimate individual risk in RCC adjuvant therapy clinical trials.

Perinephric and Sinus Fat Invasion in Stage pT3a Tumors Managed by Partial Nephrectomy.

We evaluated the influence of perinephric fat invasion (PFI) compared with sinus fat invasion (SFI) on disease-free survival (DFS) and cancer-specific survival (CSS) after partial nephrectomy (PN) for stage pT3a renal cell carcinoma (RCC). Data were recorded from the consecutive records of patients who had undergone underwent PN for cT1-T2 RCC from 2007 to 2016. Of these patients, 143 had stage pT3a with SFI or PFI found on final pathologic examination. The demographic, perioperative, and pathologic variables were reviewed. DFS and CSS analyses were performed. The factors predicting disease progression in this population were assessed. After a median follow-up period of 28 months (range 15-41 months), 19 patients (13.3%) had developed recurrence, including 5 local and 14 distant metastases, with 11 cancer-specific deaths (7.7%). No differences were found in DFS (5 years, 60.9% vs. 55.3%; log-rank P= .7) or CSS (5 years, 81% vs. 74.2%; log-rank P= .8) between the SFI and PFI groups. For the pT3a fat invasion population, the 2- and 5-year DFS and CSS rates were 83.6% and 58.6% and 93.6% and 78%, respectively. SFI (P= .5) and positive surgical margins (P= .1) did not predict for progression. On multivariate Cox regression, increased tumor size (hazard ratio, 1.5; 95% confidence interval, 1.1-1.9; P< .01) and higher tumor grade (hazard ratio, 3.6; 95% confidence interval, 1.1-4.6; P= .04) were independent predictors of disease progression in the pT3a fat invasion population. In our series of patients with pT3a RCC after PN, SFI compared with PFI was not associated with an increased risk of progression or cancer-specific death.

Prognostic heterogeneity in T3aN0M0 renal cell carcinoma according to the site of invasion

PurposeWe investigated the influence of the site of invasion on recurrence and survival in patients with pT3aN0M0 renal cell carcinoma (RCC). Materials and methodsWe reviewed the data of 266 patients with pT3aN0M0 RCC who underwent nephrectomy and divided them into the following 5 groups according to the site of invasion: perinephric invasion (PNI), sinus fat invasion (SFI), PNI and SFI without renal vein invasion (RVI) (i.e., PNI+SFI), RVI, and RVI with PNI and/or SFI (RVI+PNI±SFI). Subgroup analysis was performed to verify the differences in prognosis according to the extent of renal vein invasion using Cox regression models. ResultsA total of 111 patients (41.7%) experienced recurrence and 59 patients (22.2%) died of disease during follow-up (median = 58.1mo; interquartile range: 37.2–86.5). Patients with RVI showed significantly poorer outcomes than those with fat invasion in terms of 5-year recurrence-free survival (34.3% vs. 62.2%, P<0.001) and cancer-specific survival (62.8% vs. 84.1%; P<0.001). In multivariate analysis, RVI was an independent prognostic factor for recurrence and survival. In 94 patients with RVI, the 5-year recurrence-free survival rates were 50.0%, 33.9%, and 8.9% for the thrombus-only, the vascular wall invasion with negative surgical margin, and the vascular wall invasion with positive surgical margin groups, respectively (P<0.001), and the cancer-specific survival rates were 82.3%, 56.6%, and 20.0%, respectively (P<0.001). Wall invasion was the only independent prognostic factor for cancer-specific survival in these patients. ConclusionsPatients with pT3aN0M0 RCC with RVI have a significantly poorer prognosis than those with fat invasion. The prognosis differs according to the extent of RVI. Wall invasion should be considered a negative prognostic indicator in patients with T3a RCC.

PD66-08 PARTIAL NEPHRECTOMY IS ASSOCIATED WITH INCREASED RECURRENCE RISK AMONG CLINICAL STAGE T1 UPSTAGED TO PATHOLOGIC T3A RENAL CELL CARCINOMA

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy VI1 Apr 2017PD66-08 PARTIAL NEPHRECTOMY IS ASSOCIATED WITH INCREASED RECURRENCE RISK AMONG CLINICAL STAGE T1 UPSTAGED TO PATHOLOGIC T3A RENAL CELL CARCINOMA Paras Shah, Daniel Moreira, Vinay Patel, Arvin George, Geoffrey Gaunay, Manaf Alom, Michael Schwartz, Manish Vira, Lee Richstone, and Louis Kavoussi Paras ShahParas Shah More articles by this author , Daniel MoreiraDaniel Moreira More articles by this author , Vinay PatelVinay Patel More articles by this author , Arvin GeorgeArvin George More articles by this author , Geoffrey GaunayGeoffrey Gaunay More articles by this author , Manaf AlomManaf Alom More articles by this author , Michael SchwartzMichael Schwartz More articles by this author , Manish ViraManish Vira More articles by this author , Lee RichstoneLee Richstone More articles by this author , and Louis KavoussiLouis Kavoussi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2971AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To compare recurrence-free survival (RFS) of partial nephrectomy (PN) versus radical nephrectomy (RN) for clinical stage T1 (cT1) renal cell carcinoma (RCC) with pathologic upstaging to T3a among all comers and stratified by pT3a histologic subgroups. METHODS A retrospective analysis of 1250 patients undergoing PN or RN for cT1 RCC upstaged to pT3a was performed. Baseline characteristics were compared between treatment groups with chi-square and Student t test. RFS was estimated with the Kaplan-Meier method and evaluated as a function of treatment with log-rank test and Cox models adjusting for clinicopathologic variables. RESULTS A total of 140 (11.2%) cT1 cases were upstaged to pT3a, 49 (3.9%) after PN and 91 (7.3%) RN. RN cases had greater mean tumor size (5.5cm vs 4.2cm, p<0.001), were more likely to be of moderate/high anatomic complexity (78% vs 45%, p<0.001) and clear cell histology (95 vs 84%, P=0.035), and less likely to demonstrate positive margins (0% vs 15%, p<0.001, Table). Upstaging in RN was more frequent due to sinus fat (53% vs 14%, p<0.001) or venous invasion (45% vs 8%, p<0.001) and less frequent due to perinephric fat invasion (35% vs 80%, p<0.001, Table 1) compared to PN. PN was associated with higher recurrence risk in pT3a RCC (HR=2.04, P=0.019, Figure). Similar results were found in multivariable analysis (HR=3.17, P=0.003). After stratification by pT3a histology, PN was associated with lower RFS in perinephric (P=0.002) and sinus fat invasion (P=0.046, Figure). CONCLUSIONS PN is associated with higher recurrence risk in cT1 RCC upstaged to pT3a. Patients at high risk for pT3a upstaging may benefit from RN. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1274 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Paras Shah More articles by this author Daniel Moreira More articles by this author Vinay Patel More articles by this author Arvin George More articles by this author Geoffrey Gaunay More articles by this author Manaf Alom More articles by this author Michael Schwartz More articles by this author Manish Vira More articles by this author Lee Richstone More articles by this author Louis Kavoussi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP55-04 PERINEPHRIC VERSUS SINUS FAT INVASION IN PT3A TUMORS MANAGED BY PARTIAL NEPHRECTOMY

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy III1 Apr 2017MP55-04 PERINEPHRIC VERSUS SINUS FAT INVASION IN PT3A TUMORS MANAGED BY PARTIAL NEPHRECTOMY Pascal Mouracade, Onder Kara, Matthew Maurice, Julien Dagenais, Ercan Malkoc, Ryan Nelson, Jeremy Reese, and Jihad Kaouk Pascal MouracadePascal Mouracade More articles by this author , Onder KaraOnder Kara More articles by this author , Matthew MauriceMatthew Maurice More articles by this author , Julien DagenaisJulien Dagenais More articles by this author , Ercan MalkocErcan Malkoc More articles by this author , Ryan NelsonRyan Nelson More articles by this author , Jeremy ReeseJeremy Reese More articles by this author , and Jihad KaoukJihad Kaouk More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1697AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES With adoption of partial nephrectomy (PN), the last few years have been marked by a growth in the use of PN for complex renal masses. This has led to an overall increase in the number of tumors found to have adverse pathological features. There are two types of pathological findings in the current T3a fat invasion renal cell carcinoma (RCC): renal sinus fat invasion (SFI) and perinephric fat invasion (PFI). From an anatomical perspective, after PN, RCC with SFI could be considered more likely to develop recurrence and may be associated with worse prognosis. The aim of our study was to evaluate the influence of SFI and PFI on progression-free survival and overall survival after PN for stage pT3a RCC. METHODS We retrospectively reviewed our institutional review board-approved PN database. Data consisted of consecutive records of patients who underwent PN for cT1-3a renal cell carcinoma (RCC) between 2007 and 2016. Overall 1306 patients were included in this study. Of this cohort, 143 patients were staged pT3a with SFI (85 patients) or PFI (58 patients) on final pathology. Demographic, perioperative and pathological variables were reviewed. We compared the clinico-pathological characteristics, perioperative morbidity and oncological outcomes between SFI and PFI groups. Progression-free survival (PFS) and overall survival (OS) analyses were performed. Survival curves were compared using Log-rank test. RESULTS There were no differences between the 2 groups in terms of age, gender, race, Body mass index, Charlson comorbidity index, cTstage and surgical approach. SFI group had a higher clear cell subtype (p<0.01), Higher R.E.N.A.L score (median 9 vs. 7, p<0.01), Higher hilar (h) location (p<0.01). Positive surgical margin rate was higher in SFI group (21.1% vs. 10.3%) but the difference was not statistically significant(p=0.09). SFI group had higher warm ischemia time (median 28 vs. 21, p<0.01), while estimated blood loss (p=0.6), transfusion rate (p=0.2), Clavien complications (p=0.6) were not different between the 2 groups. After a median 28 months, there were 19 recurrences (13.3%) and 7 deaths (4.9%). When comparing the survival curves between the 2 groups, there were no differences in PFS (Log rank, p=0.5) and OS (Log rank, p=0.8). Tumors size (HR:1.5, 95% CI [1.1-1.9], p <0.01, and tumor grade (HR:3.6, 95% CI [1.1-4.6], p=0.04) were independent predictors of recurrence. CONCLUSIONS In our cohort of patients with pT3a renal cell carcinoma following partial nephrectomy, sinus fat invasion compared to perinephric fat invasion was not associated with an increased risk of progression or death. The independent predictors of recurrence in this population were tumor size and tumor grade. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e731 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Pascal Mouracade More articles by this author Onder Kara More articles by this author Matthew Maurice More articles by this author Julien Dagenais More articles by this author Ercan Malkoc More articles by this author Ryan Nelson More articles by this author Jeremy Reese More articles by this author Jihad Kaouk More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...