Outcomes of pathologic stage T3a renal cell carcinoma up-staged from small renal tumor: emphasis on partial nephrectomy

Abstract

BackgroundThe prognosis of patients with pathologic stage T3a renal cell carcinoma (RCC) that is up-staged from a small renal tumor remains controversial. We evaluated the prognosis of patients with RCC who were up-staged from clinical stage T1 to pathologic stage T3a.MethodsWe retrospectively reviewed the data of 3431 patients who were surgically treated for clinical stage T1 RCC. The survival outcomes were compared using Kaplan-Meier and Cox proportional analyses.ResultsAmong the clinical stage T1 patients, 215 (6.3%) were finally up-staged to pathologic stage T3a. Patient age (HR 1.302, 95% CI 1.018–1.046, p < 0.001), tumor diameter (HR 1.686, 95% CI 1.551–1.834, p < 0.001), and hilar location (HR 1.765, 95% CI 1.147–2.715, p = 0.010) were significantly associated with upstaging. Kaplan-Meier analyses showed significantly shorter recurrence-free, cancer-specific and overall survivals (all p < 0.001) in patients who were up-staged. Multivariate Cox analyses revealed pathologic upstaging as an independent predictor of shorter recurrence-free (HR 2.195, 95% CI 1.459–3.300, p < 0.001), cancer-specific (HR 2.238, 95% CI 1.252–4.003, p = 0.007), and overall survivals (HR 1.632, 95% CI 1.029–2.588, p = 0.037). Subgroup analysis of pathologic stage T3a showed no significant difference in survival of the partial nephrectomy group when compared to the radical nephrectomy group (all p > 0.5).ConclusionsPatients up-staged from clinical stage T1 to pathologic stage T3a RCC showed shorter survival outcomes than those without upstaging. However, partial nephrectomy, compared with radical nephrectomy, showed comparable outcomes in patients who were up-staged.

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

“…In term of follow up time, the median or mean duration period ranged from 23 to more than 60 months. Among the eligible nine studies, seven studies 12-15, 17, 25, 26 containing 10,456 patients were performed to evaluate the impact of pT3a upstaging on the RFS of cT1 RCC patients, six studies (seven cohorts) 12, 15, 24-27 containing 98,884 patients were conducted to investigate the OS and three studies (four cohorts) 12, 24, 26 containing 33,470 patients reported the CSS, respectively. Quality scores of these studies by NOS ranged from 7 to 9, which were considered adequate for the following meta-analysis.…”

“…Some recent studies have focused on the prognostic significance of pT3a upstaging in cT1 RCC undergoing nephrectomy and suggested inconsistent results. Lee et al12 demonstrated that patients with RCC upstaged from clinical stage T1 to pathologic stage T3a showed shorter survival outcomes than those without upstaging. Jeong et al 13 found that pathological T3a upstaging of cT1 RCC was associated with a poor recurrence-free survival, compared with pT1 disease.…”

A novel definition of microvessel density in renal cell carcinoma: Angiogenesis plus vasculogenic mimicry

“…The macroscopic and histological features of RCC were assessed, including tumor stage and Fuhrman nuclear grade (26). The tumor stage was defined according to the 2010 TNM classification (48). At presentation, the tumor stage was pT1 in 73, pT2 in 80 and pT3 in 30 cases, and the Fuhrman grade was I in 58, II in 90, III in 29 and IV in 6 umors.…”

Preoperative Neutrophil-to-Lymphocyte Ratio Was a Predictor of Overall Survival in Small Renal Cell Carcinoma: An Analysis of 384 Consecutive Patients

“…Among these cases, clear cell RCC was the predominant type. Due to the advancements and penetration of modern radiologic imaging techniques, the incidental detection of small renal cell carcinoma (sRCC, ≤4 cm) has been steadily increasing [3].…”