Impact of pathological T3a upstaging on oncological outcomes of clinical T1 renal cell carcinoma: a meta-analysis

Abstract

Objective: The study aims to assess the prognostic impact of pathological T3a upstaging in clinical T1 renal cell carcinoma (RCC) on clinical outcomes.Methods: We performed a systematic literature search of PMC, Embase, Web of Science, and Cochrane library from inception to April 2019 for studies that investigated the prognostic significance of pathological T3a upstaging in clinical T1 RCC after surgery and conducted a standard meta-analysis on survival outcomes.Results: Overall, nine studies including 101,505 clinical T1 RCC patients were identified, in which 5,560 (5.5%) patients were upstaged to T3a after surgical treatment. Meta-analysis results showed that pT3a upstaging from clinical T1 RCC was significantly associated with poor recurrence-free survival (RFS; pooled hazard ratio [HR] 2.16, 95% confidence interval [CI] 1.70-2.75; P<0.001), overall survival (OS; pooled HR 1.36, 95% CI 1.24-1.50; P<0.001), and cancer-specific survival (CSS; pooled HR 2.11, 95% CI 1.58-2.83; P<0.001). Subgroup analyses by surgical type demonstrated that pT3a upstaging remains a significant prognostic factor for RFS and OS in RCC patients who underwent different surgical treatments.Conclusions: Current available evidence strongly supported that postoperative pT3a upstaging has a significant negative impact on RFS, OS, and CSS in clinical T1 RCC patients. Clinical T1 RCC patients with pT3a upstaging after surgery should be closely monitored by clinician and should receive close follow-up for their poor prognosis.

Comparison of oncologic outcomes between partial nephrectomy and radical nephrectomy in patients who were upstaged from cT1 renal tumor to pT3a renal cell carcinoma: an updated systematic review and meta-analysis

“…7 Previous studies have reported that patients with upstaged pT3 RCCa from cT1 have a poorer prognosis than those without. [8][9][10] However, previous reports on the oncological consequences of partial nephrectomy (PNx) and RNx in these patients are still conflicting. [11][12][13][14][15][16][17][18][19][20][21][22] In particular, when tumors are small but cT3 cannot be excluded from preoperative imaging studies, it is very troublesome to select PNx, although it is technically feasible.…”

The Effectiveness of Partial Versus Radical Nephrectomy for pT3aN0M0 Renal Cell Carcinoma: A Propensity Score Analysis

“…The role of PN in the treatment of cT1 RCC has been well studied. While Chen et al showed that the rate of cT1 upstaged to pT3a ranged from 3.2-31%, median 5.5% [3]. Moreover, upstaged cT1/pT3a RCC was associated with poor recurrence-free survival, overall survival, and cancer-speci c survival in the most of the reports [3].…”

“…While Chen et al showed that the rate of cT1 upstaged to pT3a ranged from 3.2-31%, median 5.5% [3]. Moreover, upstaged cT1/pT3a RCC was associated with poor recurrence-free survival, overall survival, and cancer-speci c survival in the most of the reports [3]. It has been showed that several factors would affect the prognostic of pT3a RCC, such as tumor size, invasion site, tumor grade and pathology type.…”

“…Majority of cT1 RCC has consistent pathological T1 stage after surgery, while there is a rate of 3.2%-31% cT1 RCC upstaged to pT3a in the PN treatment [3]. Moreover, pT3a RCC upstaged from cT1 RCC was signi cantly associated with poor recurrence-free survival, overall survival, and cancer-speci c survival [3]. According to the Eighth Edition of the Tumor-Node-Metastasis Staging Classi cation System, pT3a is de ned based on anatomical tumor expansion including either vein, Renal pelvis or fatty in ltration, regardless of tumor size [4].…”

“…Majority of cT1 RCC has consistent pathological T1 stage after surgery, while there is a rate of 3.2%-31% cT1 RCC upstaged to pT3a in the PN treatment [3]. Moreover, pT3a RCC upstaged from cT1 RCC was signi cantly associated with poor recurrence-free survival, overall survival, and cancer-speci c survival [3].…”