Pathological T3a Upstaging of Clinical T1 Renal Cell Carcinoma: Outcomes According to Surgical Technique and Predictors of Upstaging

Abstract

PurposeTo evaluate the prognosis of pT3a upstaging from cT1 renal cell carcinoma, and to compare the outcomes of partial or radical nephrectomy in cases of pT3a upstaging.Materials and MethodsWe reviewed the records of patients who underwent partial or radical nephrectomy for cT1 at our center between January 2001 and October 2013. We compared the 2-year recurrence-free survivals for cases with pT1 or pT3a upstaging, and for partial or radical nephrectomy in cases with pT3a upstaging. Clinicopathological parameters were analyzed in univariate and multivariate analyses to evaluate their associations with upstaging.ResultsAmong the 1,009 eligible patients, 987 patients were included in the analysis. The mean follow-up was 48.5 ± 27.8 months in whole patients. The 2-year recurrence-free survival was worse in the pT3a upstaging group, compared to the pT1 group (87.3% vs. 98.7%; p < 0.001). Partial nephrectomy and radical nephrectomy had no significant difference in 2-year recurrence-free survivals (91.9% vs. 83.7%; p = 0.251). The multivariate analysis revealed that upstaging was associated with old age, cT1b stage, clinical symptoms, and a high Fuhrman grade.ConclusionsPathological T3a upstaging of cT1 renal cell carcinoma was associated with a poorer prognosis, compared to pT1 disease. However, the surgical technique (radical or partial nephrectomy) did not affect the recurrence rate. Therefore, clinicians should select the treatment method based on the clinical stage, and consider the pathological stage during the follow-up.

A preoperative model to predict pT3 upstaging in clinically localized renal cell carcinoma

“…In our study each increasing year determined a 7.1% extra risk for locally advanced tumor (OR 1.07). This observation is concordant with other reports [ 13 , 14 ].…”

Prognostic significance of the sub-classification of stage pT3a renal tumors by perinephric and sinus fat invasion

“…Srivastava et al (12) assessed 28,854 RCC patients undergoing PN, and found that 4.2% of patients with cT1a tumors were upstaged to pT3a between 1998 and 2003. A number of other studies reported a similar value, such as those by Gorin et al (13), Weight et al (14) and Jeong et al (15), which reported the rates of 3.9, 4.8 and 5.7%, respectively. The rate in the present study was 4.5%, which was similar to that of the aforementioned studies.…”

Survival Analysis of Pathological T3a Upstaging in Clinical T1 Renal Cell Carcinoma

“…A previously published series by Shah et al showed that partial nephrectomy was associated with inferior RFS, when compared with radical nephrectomy for pT3a upstaging renal tumors (18). However, Jeong et al demonstrated that there was no difference in RFS between either partial or radical nephrectomy (11). Our series also discovered that there was no difference between the two surgical approaches.…”

“…Recurrence-free survival between partial and radical nephrectomy for the patients with upstaged pT3a renal tumors. (8,10) demonstrated that there was no significant difference regarding the oncologic outcomes, while the others showed inferior RFS (7,9,11), CSS (12) and OS (12) within the pT3a upstaging group. Our study also found that patients with pT3a upstaging disease experienced reduced 3-and 5year OS, CSS and RFS rates.…”