Sinus Fat Invasion Research Articles

Combined Renal Sinus Fat and Perinephric Fat Renal Cell Carcinoma Invasion Has a Worse Prognosis Than Either Alone

Recently groups reached differing conclusions when examining the prognostic significance of renal cell carcinoma perinephric and sinus fat invasion. We evaluated the impact of these pathological features on renal cell carcinoma survival and recurrence. We identified the pathological and clinical records of 110 patients treated surgically for renal cell carcinoma with extrarenal extension at our institution between 1997 and 2007. Patients with von Hippel-Lindau disease were excluded from study. We used Kaplan-Meier survival curves with the log rank statistic to evaluate differences between groups. Cox logistic regression analysis was used to control for metastatic disease, tumor size and renal vein involvement to determine differences among the groups. Patients with perinephric plus sinus fat invasion had worse cancer specific survival than those with perinephric or sinus fat invasion alone (p <0.005). There was no difference in cancer specific survival between those with sinus vs perinephric fat invasion (p = 0.248). On multivariate analysis perinephric plus sinus fat invasion was a significant prognostic factor for death from renal cell carcinoma compared to sinus fat invasion alone (p = 0.038). Patients with combined renal sinus and perinephric fat invasion had a worse prognosis than those with either alone. Considerations should be made to stage these cases accordingly.

Distant Metastasis of Renal Cell Carcinoma With a Diameter of 3 cm or Less—Which is Aggressive Cancer?

It was previously thought that renal cell carcinoma with a diameter of 3 cm or less has low potential to cause distant metastasis. However, metastasis develops in a small number of cases, which cannot be ignored. We investigated the clinicopathological characters of small renal cell carcinoma with metastasis to further understand this condition. From January 1983 to February 2009, 165 cases of sporadic renal cell carcinoma 3 cm or less were treated at our department. Bilateral and von Hippel-Lindau disease were excluded from study. Clinicopathological parameters and outcome data were collected on each patient and analyzed. Histologically the 165 cases of primary renal cell carcinoma 3 cm or less included 151 of clear cell, 10 of papillary and 4 of chromophobe renal cell carcinoma, of which 4 had sarcomatoid differentiation, 6 had perinephric and/or sinus invasion and 20 had microvascular invasion. Overall we identified 10 metastatic cases (6.06%), of which 5 were synchronous. Univariate analysis revealed that age 60 years or greater (p = 0.0139), symptoms (p = 0.0054) and microvascular invasion (p <0.0001) were significant risk factors. Multivariate analysis showed that only microvascular invasion was a significant risk factor (p = 0.00062). Perinephric and/or sinus fat invasion was not a significant risk factor. Metastasis also develops in small renal cell carcinoma cases. Results suggest that microvascular invasion is a significant risk factor and patients with microvascular invasion should be followed more carefully.

Pathological prognostic indicators in renal cell carcinoma

ObjectiveTo analyze histological factors not routinely assessed as potential prognostic factors in renal cell carcinoma, such as tumor necrosis, microscopic vascular invasion, and sinus fat invasion. Materials and methodsA retrospective, analytical study was conducted of surgical specimens from 139 patients with localized renal cell carcinoma who underwent nephrectomy from 1993 to 2005. Tumor necrosis, microscopic vascular invasion, and sinus fat invasion were analyzed and compared to the classical factors: TNM classification, Fuhrman grade, and tumor size. For statistical analysis, variables analyzed were categorized as pT1, 2 vs pT3, 4; Fuhrman grade 1, 2 vs 3, 4; tumor size <7cm vs ≥7cm; tumor necrosis vs no tumor necrosis; microvascular invasion of sinus fat vs no invasion. Cancer-specific survival probability and disease-free survival were calculated. A descriptive and analytical statistical analysis was performed using logistic regression for univariate and multivariate analyses. Dependent variables were used to analyze cancer-specific survival rates. Disease-free survival was estimated using a Cox regression model and Kaplan-Meier curves. ResultsIn the univariate analysis, all variables analyzed had a significant influence on death for renal cell carcinoma. In the multivariate analysis, the variable having the greatest influence was Fuhrman grade (p=0,032). The variables significantly influencing disease-free survival, estimated by the Cox method, were the pT stage (p=0.038) and Fuhrman grade (p=0.048). ConclusionsIn patients with clinically localized renal cell carcinoma undergoing nephrectomy, pT stage and Fuhrman grade are the most important prognostic factors for survival and disease-free survival. Tumor necrosis, microscopic vascular invasion, and sinus fat invasion are prognostic factors for death from renal carcinoma which are associated to TNM classification, Fuhrman grade, and tumor size

Invasion of renal sinus fat is not an independent predictor of survival in pT3a renal cell carcinoma

To clarify the significance of the location of extrarenal tumour extension of renal cell carcinoma (RCC) as in the 2002 Tumour-Nodes-Metastasis classification. Renal cortical tumours with perirenal fat invasion (PFI) or sinus fat invasion (SFI) are consolidated within the pT3a grouping; tumours with SFI are close to the renal veins, lymphatics and the collecting system. This might carry a worse prognosis for disease-specific survival (DSS), but reports are limited and contradictory. We retrospectively reviewed 1244 patients treated with nephrectomy from 1988 to 2007, to identify patients with pT3a renal tumours. They were classified as having PFI or SFI. Kaplan-Meier analysis and Cox proportional hazards regression models were used to assess predictors of survival. The 230 patients who met the inclusion criteria had a median follow-up of 24 months. SFI was found in 63 (27.4%) patients and was associated with a worse 5-year DSS than the 167 (72.6%) with PFI (62.5% vs 75.0%; log rank P = 0.022). On univariate analysis, diameter (hazard ratio, HR 1.1), nuclear grade (HR 4.5), margin status (HR 5.8), lymph node metastases (HR 6.4), and systemic metastases (HR 15.4) were significant for DSS. In a multivariate model, only nuclear grade (HR 3.1), margin status (HR 8.9) and systemic metastases (HR 9.8) were independent predictors. Patients with renal tumours with SFI are more likely to die from RCC than those with PFI. However, in the present patients the presence of SFI was not an independent predictor of DSS.

Renal Sinus Fat Invasion in pT3a Clear Cell Renal Cell Carcinoma Affects Outcomes of Patients Without Nodal Involvement or Distant Metastases

According to the 2002 American Joint Committee on Cancer TNM classification, perinephric and renal sinus fat invasion are classified as pT3a renal cell carcinoma. However, only a few studies have assessed the impact of sinus fat invasion on patient survival and with controversial results. We analyzed the impact of sinus fat invasion on cancer specific survival in a cohort of patients with pT3a clear cell renal cell carcinoma. We retrospectively analyzed data on 115 consecutive patients treated with open radical nephrectomy for unilateral, sporadic pT3a clear cell renal cell carcinoma at our department from 1989 to 2006. All pathological specimens were rereviewed by a single uropathologist. The prognostic role of sinus fat invasion in cancer specific survival was assessed by Cox proportional hazards regression models. Ten patients had direct ipsilateral adrenal invasion and were excluded from analysis. A total of 105 patients with clear cell renal cell carcinoma were evaluated. Median followup was 38 months. In the overall population sinus fat invasion did not reach independent predictive status in terms of cancer specific survival on multivariate Cox regression analysis after adjusting for age, performance status, tumor dimension, tumor grade, synchronous metastases, nodal involvement, sarcomatoid differentiation and coagulative necrosis. In the subset of patients with pNx/pN0 M0 (83) the actuarial 5-year cancer specific survival was 71.9% and 45.5% for those with perinephric fat invasion only and sinus fat invasion, respectively (p = 0.025). Sinus fat invasion achieved an independent predictive role on multivariable Cox regression analysis (p = 0.048, HR 2.06). Sinus fat invasion in clear cell renal cell carcinoma significantly affects cancer specific survival in patients without nodal or distant metastases. However, sinus fat invasion is not associated with worse cancer specific survival in cases of metastatic disease.

Impact of several histopathological prognosticators and local tumour extension on oncological outcome in pT3b/c N0M0 renal cell carcinoma

To investigate the prognostic relevance of different histopathological features and local tumour extension in patients with pT3b/c N0M0 renal cell carcinoma (RCC), as recently new proposals of reclassifying tumour fat invasion in pT3b/c RCC have been made but the effect of other histopathological tumour characteristics and combinations thereof with tumour invasion has yet to be determined in these patients. Between 1990 and 2006, 1943 patients underwent surgical treatment for renal tumours in our institution, of which 175 patients (8.7%) had pT3b/c RCC. After exclusion of 57 patients (32.6%) with lymph node and/or distant metastases at the time of diagnosis, 118 (67.4%) remained for retrospective analysis. Different histopathological features and local tumour extension were studied for their association with cancer-specific-survival (CSS) and progression-free-survival (PFS) by univariate and multivariate analyses. Histopathology was reviewed and revised according to the 2002 Tumour-Nodes-Metastasis (TNM) classification system by one pathologist (S.B.). CSS and PFS were estimated by the Kaplan-Meier method. Follow-up data were obtained from 110 patients at a median (range) of 3.2 (0.3-16.1) years. In univariate analysis, microvascular invasion (MVI) and capsular invasion increased the risk of tumour progression by 2.05- and 2.72-times (P = 0.037 and P < 0.001). Overall, tumour fat invasion (TFI) and the presence of areas composed by cells with eosinophilic cytoplasm were associated with a higher risk of progression (P = 0.001 and P = 0.011) and reduced CSS (P = 0.037 and P = 0.017). In multivariate analysis, MVI and capsular invasion were associated with a two-fold increased risk of dying from cancer (hazard risk ratio, HR 2.22, P = 0.045 and HR 2.31, P = 0.011). TFI in general (P = 0.004) and specifically coexistent perirenal fat invasion (PFI) and renal sinus fat invasion (RSFI) were associated with a three-fold increased risk of developing tumour progression (HR 3.36, P = 0.001). The 10-year CSS and PFS rates were 39% and 36% for all patients, 47% and 45% for pT3b/c RCC with no PFI or RSFI, and 25% and 10% for PFI + RSFI. Patients with pT3b/c RCC with MVI, capsular invasion, TFI and especially PFI + RSFI, have a markedly reduced prognosis compared with patients with pT3b/c RCC without these features. When these results are corroborated by additional studies and external validation, modification of the TNM classification system would be a sensible consequence.

Reappraisal of T3N0/NxM0 renal cell carcinoma: significance of extent of fat invasion, renal vein invasion, and adrenal invasion

T3 renal cell carcinoma (RCC) is a heterogeneous group of tumors that are substaged based on perirenal or sinus fat invasion, adrenal invasion, and renal vein invasion. To evaluate whether the extent of fat invasion (minimal versus extensive) and direct adrenal gland invasion, renal vein invasion with or without concurrent fat invasion has a similar prognosis, we retrospectively reviewed 198 T3N0/NxM0 RCCs in a single academic tertiary hospital. Fat invasion was subdivided as minimal (< or =5 mm into the fat) or extensive (>5 mm) invasion. Direct adrenal invasion was defined as contiguous involvement of ipsilateral adrenal gland. Among the 198 T3 RCCs, minimal and extensive fat invasions were identified in 57 and 61 cases, respectively; renal vein invasion and direct adrenal invasion were seen in 66 and 14 cases. The patients' average age was 62.9 years, and 145 patients were male and 53 were females. The 2-year and 5-year survival rates were 85% and 56% for minimal fat invasion, 76% and 70% for extensive fat invasion, and 55% and 32% for renal vein invasion, respectively. There was no difference of survival in patients with T3b (renal vein invasion) RCC stratified by presence or absence of concurrent fat invasion. The 2-year and 5-year survival rates for adrenal invasion were 31% and 21%, respectively, which was significantly worse than that of fat or renal vein invasion. Multivariate analysis showed that nuclear grade, sarcomatoid differentiation, and subgrouping of pT3 RCC (fat invasion, renal vein invasion, and adrenal invasion) remained independent predictors of patient's overall survival. In conclusion, our study shows that T3 RCCs with minimal or extensive perinephric fat invasion has a similar prognosis and is significantly more favorable than that of renal vein invasion regardless of presence or absence of concurrent fat invasion. In contrast, tumors with adrenal gland invasion carry a far worse prognosis than perinephric fat or renal vein invasion and thus supporting a separate stage category.

Prognostic Significance of Perinephric Fat Infiltration and Tumor Size in Renal Cell Carcinoma

It is controversial that perinephric fat infiltration has an impact on survival in patients with renal cell carcinoma. Therefore, we evaluated the influence of perinephric fat infiltration and tumor size on patient survival. We retrospectively reviewed the medical records of 783 and 77 patients with pT1-2 (cN0M0) and pT3a (cN0M0) renal cell carcinoma, respectively. Sporadic unilocular noncystic renal cell carcinoma was included. Univariate and multivariate analyses of prognostic factors, including perinephric fat infiltration, on cancer specific and disease-free survival were performed. Median followup was 56.0 months after surgery. Patients with pT1-2 and pT3a tumors had a 5-year cancer specific survival rate of 96.1% and 84.9%, and a 5-year disease-free survival rate of 93.4% and 74.7%, respectively (each p <0.01). Age, tumor size and Fuhrman nuclear grade were independent prognostic factors for cancer specific and disease-free survival, whereas perinephric fat infiltration was significant only for disease-free survival. However, perinephric fat infiltration had a significant effect on cancer specific survival in patients with pT3a tumors more than 7 cm (p = 0.001). In contrast, patients with pT3a tumors 7 cm or less had cancer specific and disease-free survival similar to that of patients with pT2 tumors. Recurrence of pT3a tumors greater than 7 cm was observed in 44% of patients but in only 14.6% of those with pT3a tumors 7 cm or less (p = 0.029). In contrast to the recurrence of tumors 7 cm or less, recurrence of pT3a tumors more than 7 cm usually developed at multiple sites with a large tumor burden and it progressed rapidly. Consequently 85% of patients with recurrence of pT3a tumors larger than 7 cm died of renal cell carcinoma compared with 33% of those with recurrence of pT3a tumors 7 cm or less (p = 0.001). In pT3a renal cell carcinoma tumor size was the strongest prognostic factor of disease-free and cancer specific survival. Perinephric fat infiltration was an independent prognostic factor for disease-free survival but not for cancer specific survival due to the less aggressive behavior of small (7 cm or less) pT3a tumors after recurrence. Tumor size and perinephric fat infiltration should be included in T3a renal cell carcinoma staging.

Proposal of an Improved Prognostic Classification for pT3 Renal Cell Carcinoma

The prognostic accuracy of the current TNM 2002 staging system for locally advanced renal cell carcinoma has been questioned. To contribute to the development of a more accurate classification for this stage of disease we assessed the correlation between patterns of invasion in the pT3 category and outcomes in a large multi-institutional series. Pathological data and clinical followup on 513 pT3 renal cell carcinoma cases treated with radical nephrectomy between 1983 and 2005 at 3 Italian academic centers were retrospectively reviewed. Cause specific survival rates were calculated with the Kaplan-Meier method and multivariate analysis was performed using the Cox proportional hazards regression model. Estimated overall 5-year cause specific survival was 50.1% at a median followup of 61.5 months in survivors. The current TNM classification was not a significant outcome prognosticator. Patients with a tumor invading only the perirenal or sinus fat were at lowest risk for death from the disease. Patients at intermediate risk had tumors with invasion of the venous system alone. Simultaneous perirenal fat and sinus fat invasion or perirenal fat and vascular invasion as well as adrenal gland involvement characterized high risk tumors. Low risk tumors could be further divided into 2 groups with different outcomes based on a size cutoff of 7 cm. Our classification was a significant predictor of survival on multivariate analysis as well as M stage, N stage, Fuhrman grade and tumor size. We confirm that the prognostic usefulness of the current 2002 TNM system for pT3 renal cell carcinoma is limited. We have identified 4 groups of tumors with distinct patterns of invasion and significantly different survival probabilities in this category. Large prospective series are needed to validate these findings.

Imaging features of helical computed tomography suggesting advanced urothelial carcinoma arising from the pelvocalyceal system

Urothelial carcinoma is the most common malignant tumor arising from the pelvocalyceal system. Helical computed tomography (CT) is probably the best preoperative-stage modality for the determination of treatment plan and prognosis. To obtain helical CT imaging features suggesting advanced pelvocalyceal urothelial carcinoma. Preoperative CT images in 44 patients with pelvocalyceal urothelial carcinoma were retrospectively reviewed and correlated with the pathological examination to determine imaging features suggesting stage III or IV of the disease. Pathological stages revealed stage I in 16, stage II in three, stage III in 17, and stage IV in eight patients. Seven patients had metastatic lymph nodes. CT imaging showed that renal parenchymal invasion, sinus fat invasion, and lymph node metastasis were highly suggestive of advanced urothelial cell carcinoma (P<0.05). Helical CT sensitivity, specificity, and accuracy for advanced pelvocalyceal urothelial carcinoma were 76% (19/25), 84% (16/19), and 80% (35/44), respectively. Preoperative helical CT may suggest imaging features of advanced urothelial carcinoma, influencing treatment plan and patient prognosis, even though its accuracy is not so high.

Location of Extrarenal Tumor Extension Does Not Impact Survival of Patients With pT3a Renal Cell Carcinoma

The current TNM classification for pathological pT3a renal cell carcinoma includes patients with perinephric or sinus fat invasion, suggesting that the prognoses are similar for these pathological findings. However, sinus fat invasion was proposed by some investigators to be an independent predictor of inferior cancer specific outcome following surgical treatment. To assess and improve the predictive ability of the current pT3a primary tumor classification we evaluated the prognostic significance of location of extrarenal tumor extension on cancer specific survival following surgery. The database of 3,470 patients at our institution who were treated for renal cell carcinoma from 1990 to 2006 was searched for those with pT3a tumors managed by partial or radical nephrectomy. Patients with nonrenal cell carcinoma histology, direct adrenal invasion or a followup of less then 6 months were excluded from analyses. The prognostic importance of all clinical and pathological variables was investigated using Cox proportional hazards regression. A total of 365 patients with pT3a renal cell carcinoma and a mean followup of 33.5 months (range 6.1 to 158.6) met study inclusion criteria and they comprise the data set for this analysis. There was no difference in 5-year cancer specific survival between 166 patients (45.5%) with SF invasion and 199 (54.5%) with PF invasion only (50.8% and 54.1%, p = 0.782 respectively). On univariate analyses neither sinus fat invasion nor the location of extrarenal extension, assessed as perinephric fat vs sinus fat vs perinephric plus sinus fat, correlated with cancer specific survival following surgical treatment (HR 1.052, p = 0.783 and HR 1.072, p = 0.543, respectively). After adjusting for the effects of nodal and systemic metastases tumor grade and sarcomatoid differentiation remained independent predictors of renal cell carcinoma specific survival in our pT3a cohort of patients (HR 1.508, p = 0.003 and HR 1.810, p = 0.018, respectively). In contrast to previously reported observations, in our cohort of surgically treated patients with pT3a renal cell carcinoma the location of extrarenal extension was not an important prognosticator of cancer specific mortality. Based on our findings we confirm that perinephric and/or sinus fat should be similarly subclassified in the primary tumor staging system.

Patients With pT1 Renal Cell Carcinoma Who Die From Disease After Nephrectomy May Have Unrecognized Renal Sinus Fat Invasion

Prior studies suggest that the renal sinus permits early tumor spread in otherwise localized renal cell carcinoma (RCC) tumors. We hypothesized that renal sinus fat invasion may be unrecognized in pT1 patients who subsequently die from RCC. Between 1985 and 2002, we identified 577 patients who underwent radical nephrectomy for localized pT1 clear cell RCC as reviewed by a single urologic pathologist (J.C.C.). Among these patients, 49 died from RCC including 33 who had their original nephrectomy specimen stored in formalin. These specimens were then resectioned with thin cuts of the renal sinus and reviewed by the same pathologist. For comparison, 33 patients who did not die from RCC (controls) also had their original nephrectomy specimen resectioned. Among the 33 patients who died from seemingly localized RCC, 14 (42%) had previously unrecognized renal sinus fat invasion compared with 2 (6%) of the controls (P<0.001). In addition, 19 (58%) patients who died from RCC had renal sinus small vein (microscopic venous) invasion, a pathologic feature not currently incorporated into the TNM staging system for RCC. This feature was present in 7 (21%) of the controls (P=0.003). In total, 22 (67%) patients who died from RCC had unrecognized renal sinus fat or small vein invasion compared with 7 (21%) of the controls (P<0.001). We conclude that renal sinus fat invasion is an important adverse pathologic feature that is clearly underreported in the literature. Appropriate assessment of nephrectomy specimens should include proper sampling of the renal sinus even for seemingly localized tumors.

507: Patients with PT1 Renal Cell Carcinoma who Die from Disease after Nephrectomy may have Unrecognized Renal Sinus Fat Invasion

You have accessJournal of UrologyModerated Poster 14, Sunday, May 20, 2007, 3:30 - 5:30 pm1 Apr 2007507: Patients with PT1 Renal Cell Carcinoma who Die from Disease after Nephrectomy may have Unrecognized Renal Sinus Fat Invasion R. Houston Thompson, Michael L. Blute, Amy E. Krambeck, Christine M. Lohse, James S. Magera, Bradley C. Leibovich, Eugene D. Kwon, Igor Frank, and John C. Cheville R. Houston ThompsonR. Houston Thompson More articles by this author , Michael L. BluteMichael L. Blute More articles by this author , Amy E. KrambeckAmy E. Krambeck More articles by this author , Christine M. LohseChristine M. Lohse More articles by this author , James S. MageraJames S. Magera More articles by this author , Bradley C. LeibovichBradley C. Leibovich More articles by this author , Eugene D. KwonEugene D. Kwon More articles by this author , Igor FrankIgor Frank More articles by this author , and John C. ChevilleJohn C. Cheville More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)30747-XAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "507: Patients with PT1 Renal Cell Carcinoma who Die from Disease after Nephrectomy may have Unrecognized Renal Sinus Fat Invasion." The Journal of Urology, 177(4S), p. 169 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 177Issue 4SApril 2007Page: 169 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information R. Houston Thompson More articles by this author Michael L. Blute More articles by this author Amy E. Krambeck More articles by this author Christine M. Lohse More articles by this author James S. Magera More articles by this author Bradley C. Leibovich More articles by this author Eugene D. Kwon More articles by this author Igor Frank More articles by this author John C. Cheville More articles by this author Expand All Advertisement PDF downloadLoading ...

Renal Cell Carcinoma and the Renal Sinus

Renal sinus fat invasion was incorporated as one of the parameters for pT stage definition of renal cell carcinoma (RCC) only in the latest 2002 American Joint Committee on Cancer/tumor-node-metastasis staging protocol. The current pT3a subcategory (in addition to adrenal gland involvement) groups 2 modes of extrarenal extension by RCC, either by peripheral perinephric fat extension or by renal sinus fat invasion. Recent prospective studies have shown that with more directed gross sampling and histologic evaluation, renal sinus invasion is actually more commonly diagnosed than previously reported, or when compared with retrospectively sampled RCC nephrectomy specimens. These studies have demonstrated that renal sinus invasion is the principal pathway for extrarenal extension for clear cell RCC; the incidence of which is related to size (tumors greater than 4 cm more frequently involve the renal sinus). More significantly, a recent retrospective study of pT3a clear cell RCC nephrectomy specimens showed that tumors invading the renal sinus fat portend a more aggressive outcome than tumors invading only the peripheral perinephric fat. Clear cell RCCs invading the renal sinus are more likely to have higher nuclear grade, regional lymph node involvement and sarcomatoid transformation than tumors invading only the perinephric fat. Given the importance of renal sinus invasion, sampling strategies for nephrectomy specimens should be modified to focus in this region as appropriate and pathologists should be familiar with the histologic criteria for staging renal sinus invasion.

Renal veins and venous extension in clear cell renal cell carcinoma

AbstractThe 2002 TNM formulation defines a pT3b tumor as one that ‘extends into the renal vein or its segmental (muscle containing) branches.' This definition elicits uncertainty when veins with little muscle are involved or the relationship to the main renal vein is unknown. The diameter and medial thickness of 10 normal renal venous systems were studied and compared to sinus veins involved in 54 pT3b clear cell renal cell carcinomas (CC). All tumors were grossly examined and sampled for histology by the author. An immunoperoxidase cocktail containing CD 31 and actin, Masson trichrome and elastic stains were employed to aid identification of intravenous tumor. The venous dissections showed variable numbers of primary and secondary divisions with substantial overlap in diameter and medial thickness. The medial thickness decreased with each proximal division and ranged from being nonexistent to being thick. Study of the 54 pT3b CC revealed that the initial phase of extrarenal extension involved large caliber veins draining the primary tumor. With extensive venous involvement, tumor invaded through the vein wall into sinus fat or demonstrated retrograde venous extension into adjacent cortex. Correlation between gross and histology revealed that most nodules of tumor within the sinus fat contained evidence of pre-existing veins. The following observations were made: (1) the diameter of a sinus vein or the quantity of muscle is a poor indicator of vein segment or relationship to the main renal vein; therefore, the wording used to define pT3b should be clarified; (2) extrarenal spread in CC begins with intravenous extension whereas sinus fat invasion is usually secondary; (3) retrograde venous extension occurs in cases with massive renal vein involvement; and (4) nodules within the sinus fat usually represent venous involvement.

Impact of Tumor Size on the Predictive Ability of the pT3a Primary Tumor Classification for Renal Cell Carcinoma

The accuracy of the pT3a primary tumor classification for renal cell carcinoma has been questioned recently. We investigated the association of perinephric and renal sinus fat invasion with death from renal cell carcinoma independent of tumor size. We identified 2,165 patients treated with open radical nephrectomy or nephron sparing surgery for clinically localized, sporadic pT1a, pT1b, pT2 or pT3a renal cell carcinoma between 1970 and 2002. Patients with pT3a disease were then subdivided into 3 groups according to tumor size to match the size definitions for the pT1a, pT1b and pT2 tumor classifications. There were 834 patients with pT1a RCC, 674 with pT1b, 494 with pT2 and 163 with pT3a RCC. At last followup 317 patients died of RCC at a median of 3.8 years following surgery. The median followup among the 1,087 patients still alive at last followup was 7.8 years (range 0 to 34). The risk ratios (95% CI) for the association between fat invasion and death from RCC among patients with tumors 4 cm or smaller, 4 to 7 cm and more than 7 cm were 6.15 (1.84-20.50, p = 0.003), 4.12 (2.50-6.78, p <0.001) and 2.13 (1.53-2.97, p <0.001), respectively. These associations remained statistically significant in a multivariate analysis that included nuclear grade and histological coagulative tumor necrosis. Peripheral perinephric and renal sinus fat invasion was associated with death from RCC independent of tumor size. Our data contradict reports suggesting that pT3a tumors should be reclassified according to tumor size only.

712: Is Renal Sinus Fat Invasion the Same as Perinephric Fat Invasion for PT3A Renal Cell Carcinoma?

You have accessJournal of UrologyDiscussed Poster, Monday, May 22, 2006, 1:00 - 4:00 pm1 Apr 2006712: Is Renal Sinus Fat Invasion the Same as Perinephric Fat Invasion for PT3A Renal Cell Carcinoma? R. Houston Thompson, Bradley C. Leibovich, John C. Cheville, W. Scott Webster, Christine M. Lohse, Eugene D. Kwon, Igor Frank, Horst Zincke, and Michael L. Blute R. Houston ThompsonR. Houston Thompson More articles by this author , Bradley C. LeibovichBradley C. Leibovich More articles by this author , John C. ChevilleJohn C. Cheville More articles by this author , W. Scott WebsterW. Scott Webster More articles by this author , Christine M. LohseChristine M. Lohse More articles by this author , Eugene D. KwonEugene D. Kwon More articles by this author , Igor FrankIgor Frank More articles by this author , Horst ZinckeHorst Zincke More articles by this author , and Michael L. BluteMichael L. Blute More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)32948-3AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "712: Is Renal Sinus Fat Invasion the Same as Perinephric Fat Invasion for PT3A Renal Cell Carcinoma?." The Journal of Urology, 175(4S), p. 230 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 175Issue 4SApril 2006Page: 230 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information R. Houston Thompson More articles by this author Bradley C. Leibovich More articles by this author John C. Cheville More articles by this author W. Scott Webster More articles by this author Christine M. Lohse More articles by this author Eugene D. Kwon More articles by this author Igor Frank More articles by this author Horst Zincke More articles by this author Michael L. Blute More articles by this author Expand All Advertisement PDF DownloadLoading ...

IS RENAL SINUS FAT INVASION THE SAME AS PERINEPHRIC FAT INVASION FOR pT3a RENAL CELL CARCINOMA?

Perinephric and renal sinus fat invasion are classified as pT3a renal cell carcinoma (RCC) according to the 2002 American Joint Committee on Cancer. We investigated the prognostic significance of each of these pathological features using a cohort of pT3a patients. Between 1970 and 2002, 205 patients without direct adrenal invasion underwent nephrectomy for pT3a clear cell RCC. The associations of fat invasion with death from RCC were evaluated using Cox proportional hazards regression models. Of the 162 patients with perinephric fat invasion and 43 patients with renal sinus fat invasion 95 (59%) and 31 (72%), respectively, died of RCC. Patients with renal sinus fat invasion were 63% more likely to die of RCC compared with those with perinephric fat invasion (RR 1.63, 95% CI 1.09-2.46, p=0.018). In addition, the risk of death persisted in multivariate analysis after adjusting for regional lymph nodes and distant metastases (RR 1.91, 95% CI 1.26-2.89, p=0.002) and after adjusting for the Mayo Clinic SSIGN (stage, size, grade and necrosis) score (RR 1.90, 95% CI 1.25-2.88, p=0.003). Our results indicate that clear cell tumors invading the renal sinus fat are more aggressive than tumors with perinephric fat involvement. We believe both of these features should be individually assessed during routine pathological examination. External validation is needed before suggesting a change to the TNM staging system.

CANCER SPECIFIC SURVIVAL FOR PATIENTS WITH pT3 RENAL CELL CARCINOMA—CAN THE 2002 PRIMARY TUMOR CLASSIFICATION BE IMPROVED?

The 2002 primary tumor classification for renal cell carcinoma (RCC) does not distinguish between patients with tumor thrombus involving the renal vein only and those with inferior vena cava tumor thrombus below the diaphragm. We evaluated the association of tumor thrombus level and fat invasion with outcome to determine if further subclassification would improve the prognostic accuracy of the current classification. We studied 675 patients treated with radical nephrectomy or nephron sparing surgery for pT3a (206, 30.5%), pT3b (422, 62.5%), pT3c (19, 2.8%) or pT4 (28, 4.2%) RCC at the Mayo Clinic between 1970 and 2000. Associations with outcome were evaluated using Cox proportional hazards regression. There were 531 deaths from RCC at a median of 1.5 years following nephrectomy. Patients with pT3b RCC and level I, II or III tumor thrombus were significantly more likely to die of RCC compared to patients with pT3b RCC and level 0 tumor thrombus (risk ratio 1.62, p <0.001). Patients with peripheral perinephric or renal sinus fat invasion were also more likely to die of RCC compared to patients without fat invasion (risk ratio 1.87, p <0.001). Therefore, patients with pT3 RCC were reclassified into 4 groups as thrombus level 0 without fat invasion, fat invasion only, thrombus level 0 with fat invasion or thrombus level I, II or III without fat invasion, and thrombus level I, II or III with fat invasion or thrombus level IV. This reclassification significantly improved prediction of death from RCC compared with the current classification (c indexes of 0.61 versus 0.55, respectively). Further subclassification of the primary tumor classification for patients with pT3 RCC improved prognostic accuracy.

Colloidal gold

Renal oncocytoma is the most common benign epithelial renal neoplasm. Several adverse features that would typically increase the stage of renal cell carcinomas are not uncommon in renal oncocytoma, including perinephric, sinus fat, or renal vein invasion. Herein, we report the largest single institutional series of renal oncocytoma with adverse pathologic features. The cohort comprised 50 patients, 38 were men (76%) and 12 were women (24%), with a mean age of 68 years (range, 50–87 years). All cases were diagnosed on nephrectomy specimens. No laterality predilection was noted. The tumors ranged in size from 1.5–15.7 cm (mean, 5.3 cm). Adverse pathologic features included perinephric fat invasion (n = 25; 50%), renal sinus fat invasion (n = 9; 18%), and renal vein invasion (n = 5; 10%). More than one adverse feature was seen in 11 tumors (22%). All tumors showed diffuse reactions to KIT (n = 40; 100%) and cyclin D1 (n = 27; 100%). Keratin 7 highlighted rare (<5%) scattered cells, as well as entrapped renal tubules (n = 21; 100%). Reaction to DOG1 was patchy in three tumors (n = 27; 11%) while reactions to vimentin (n = 31) and Hale colloidal iron special stain (n = 30) were negative. On follow-up, no tumor recurrence or metastasis was observed over a follow-up range of 1–144 months (mean, 54 months; median, 60 months). Our data suggest that adverse pathologic features in renal oncocytoma do not alter their benign course.