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PD-1 positivity of tumor-infiltrating lymphocytes was associated with adverse pathological criteria and independent prognostication of worse survival outcomes. PD-L1 positivity of tumor cells was an independent prognosticator of favorable survival outcomes in cases of organ confined disease.

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HoLEP is a safe, highly efficacious and a size-independent procedure.

INTRODUCTION AND OBJECTIVES: We investigated the prognostic significance of the various manifestations of extrarenal extension which comprise pathologic stage T3a renal cell carcinoma (RCC) among patients treated with extirpative therapy for nonmetastatic disease.METHODS: A retrospective review of 595 patients who underwent nephrectomy for pathologically-confirmed T3aN0/NxM0 clear cell RCC between 1970 and 2011 was performed. All pathologic slides were re-reviewed by a single urologic pathologist. Associations of the type of extrarenal extension (perinephric fat, renal sinus fat, and renal vein in isolation or in any combination) with disease progression, death from RCC, and death from any cause were evaluated using Cox models adjusting for demographic and pathologic features.RESULTS: Overall, perinephric fat invasion, renal sinus fat invasion, renal vein tumor thrombus, and multiple sources of extrarenal extension were present in 160 (27%), 59 (10%), 167 (28%), and 209 (35%) patients, respectively. Median follow-up after surgery was 9.1 years (IQR 6.7, 13.2), during which time 343 patients developed disease progression at a median of 1.5 years (IQR 0.5-4.3), 271 patients died from RCC at a median of 3.5 years (IQR 1.6-7.3), and 463 patients died from any cause at a median of 4.9 years (IQR 2.0-10.0) following surgery. No significant differences in the rates of disease progression, death from RCC, or death from any cause were observed in the presence of isolated perinephric fat invasion, renal sinus fat invasion, or renal vein tumor thrombus. However, on multivariable analyses, patients with multiple sources of extrarenal extension were at a significantly increased risk of disease progression (HR 1.31, 95%CI¼1.05-1.64, P¼0.017), death from RCC (HR 1.64, 95%CI¼1.28-2.11, P<0.001), and death from any cause (HR 1.31, 95%CI¼1.08-1.60, P¼0.007) compared to patients with an isolated source of extrarenal extension.CONCLUSIONS: Isolated involvement of the perinephric fat, renal sinus fat, or renal vein carry similar prognostic weight, justifying grouped classification as T3a in the contemporary AJCC primary tumor classification. However, presence of multiple sources of extrarenal extension is associated with higher risk for disease progression, cancerrelated death, and death from any cause after nephrectomy. If validated, these findings may help refine risk-stratification of non-metastatic T3a RCC.