No Detection of Pseudocapsule of Tumor-Parenchyma Interface on Multidetector Computed Tomography (MDCT) Images: Clinical Significance and Histological Reflections in Renal Cell Carcinoma

Abstract

Pseudocapsule (PS) of tumor-parenchyma interface (TPI) can be detected by MDCT (ctPS) in renal cell carcinoma (RCC) with exceptions. We aim to study the prognostic implications and histological reflections of no detection of ctPS in RCC. Patients and Methods: A total of 210 RCC patients who had MDCT examination and received nephrectomy in our institution were included in the analysis. Absence or presence of ctPS was recognized, and its associations with overall survival (OS) and progression-free survival (PFS), pathological PS (pPS) and vasculature were studied. Results: A total of 172 (81.9%) patients were recognized to have a ctPS and 38 (18.1%) had no detection of it. They had comparable histology, stage, grade, and necrosis. Patients without a ctPS had significantly shortened overall survival (OS, p = 0.001) and progressionfree survival (PFS, p <0.001), the significance of which persisted in multivariable analysis (OS, HR 3.104, p = 0.003; PFS, HR 3.313, p = 0.001). Nearly all tumors (34/38, 89.4%) without a ctPS actually had a pPS being detected and incompleteness of pPS was also irrelevant (p = 0.739). Compared with ctPS presence, those without a ctPS had significantly thinned pPS (0.36 vs 0.43 mm, p = 0.005). In clear-cell histology, those without a ctPS also contained increased vascular density and cross-sectional area of vessels with long diameter ≥200 um in the pPS layer (p = 0.005 and 0.011) and increased vascular density in the 500 um layer outside pPS (p = 0.017). Conclusion:Absence of ctPS on MDCT significantly increases the risk of adverse clinical outcome in RCC. It is the reflection of a thinner pPS and enriched vasculature of TPI rather than absence of pPS itself.

Association between decreased ipsilateral renal function and aggressive behavior in renal cell carcinoma

“…Author details 1 Department of Urology, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul 03080, Korea. 2 Department of Urology, Seoul National University College of Medicine, Seoul, South Korea.…”

“…Renal cell carcinoma (RCC) incidence is increasing [ 1 ], but a clinical hurdle regarding its treatment exists owing to its heterogeneous clinical characteristics, leading to variable patient survival outcomes [ 2 ]. Although TNM stage and Fuhrman nuclear grade are well-known strong independent prognostic factors after RCC surgical treatment [ 3 , 4 ], current classifications cannot perfectly stratify risk levels [ 2 ].…”

“…Renal cell carcinoma (RCC) incidence is increasing [ 1 ], but a clinical hurdle regarding its treatment exists owing to its heterogeneous clinical characteristics, leading to variable patient survival outcomes [ 2 ]. Although TNM stage and Fuhrman nuclear grade are well-known strong independent prognostic factors after RCC surgical treatment [ 3 , 4 ], current classifications cannot perfectly stratify risk levels [ 2 ]. Accordingly, risk factors have been investigated using radiologic assessment, such as ill-defined infiltrative growth pattern [ 5 ] or absence of pseudocapsule evaluated through multidetector computed tomography (MDCT) [ 2 ] however, preoperative diagnostic accuracy is limited [ 5 ].…”

“…Therefore, a high degree of compression or direct invasive/infiltrative growth may aggravate organ injury, ultimately leading to decreased ipsilateral renal function. This may be triggered by pathological characteristics, including a thin pseudocapsule, which cannot buffer tumor pressure [ 2 ] a pathologically infiltrative growth pattern [ 8 ], which is now acknowledged as an aggressive feature [ 9 ] or pseudocapsular invasion [ 3 ].…”

The Diagnostic Value of Serum Ang, VEGF, and CRP Combined with the Chinese Medicine Antitumor Formula in the Treatment of Advanced Renal Carcinoma

“…Prolonging the survival time of patients with advanced renal cell carcinoma is the focus of clinical research. However, no optimum remedies for renal cancer have been found at present, and some studies have shown that traditional Chinese medicine (TCM) has unique advantages in the treatment of malignant urinary tumors [ 8 – 10 ]. Since renal cancer is an immune-related malignant tumor, the application of TCM treatment based on the concept of holistic treatment and syndrome differentiation is beneficial to improve the body tolerance of patients and control the progression of renal cancer.…”