Perinephric and renal sinus fat infiltration in pT3a renal cell carcinoma: possible prognostic differences

Abstract

effects of PN, RS or RS + PN fat infiltration, univariable and multivariable Cox proportional hazard regression models were applied, including lymph node status, metastases, presence of sarcomatoid features and tumour necrosis, Fuhrman's grade, Karnofsky performance status, and tumour size. RESULTSPN fat invasion alone was present in 58, RS in 21, and PN + RS in 27 patients. The median follow-up was 2.9 years; 49 patients died from RCC. In univariable and multivariable analyses RS fat infiltration was an unfavourable prognostic factor (adjusted hazard ratio, HR, 2.24, P = 0.019). Univariable analysis of RS + PN fat infiltration showed the worst prognostic effect (HR 3.25, P < 0.001). In multivariable analysis this combination was an independent prognostic factor (HR 2.75, P = 0.007), as was the presence of metastasis (HR 5.64, P < 0.001). In this group of RS + PN fat infiltration the 5-year cancer-specific survival was 31%. CONCLUSIONUnivariable and multivariable analyses showed that the combination of RS and PN fat infiltration is an independent unfavourable prognostic marker. We recommend that perirenal fat infiltration should be further differentiated into RS fat or PN infiltration in the TNM classification. This will better stratify patient prognosis and might allow those in need of adjuvant therapy to be identified. KEYWORDSrenal cell cancer, stage pT3a, perirenal, fat infiltration, renal sinus Study Type -Prognostic (case series) Level of Evidence 4 OBJECTIVETo evaluate the influence of perinephric (PN) and renal sinus (RS) fat infiltration on cancer-specific survival beyond other prognostic factors, as the Tumour-NodeMetastasis (TNM) classification system defines stage T3a renal cell carcinoma (RCC) as infiltration of perirenal fat and/or direct infiltration of the adrenal gland. Perirenal fat invasion is differentiated into RS and PN fat infiltration, but not further classified for the prognosis.

Possible Role of Sonic Hedgehog and Epithelial-Mesenchymal Transition in Renal Cell Cancer Progression

“…In clinical situations, RCC often metastasizes to bone, which may cause pain, bone fracture, immobility, and decreased quality of life. Our IHC results showed that ON expression led to a significantly higher chance of renal vein sinus invasion, which is known to be related to worse prognosis [28]. Taken together, these results suggest that ON expression in RCC may show higher potential for invasion and future metastasis.…”

Struktur von Biobanken für die urologische Forschung

“…In einer sog. "imperativen Situationen" waren eine schlechte Tumordifferenzierung (Fuhrman Grad 3) sowie das bilaterale Auftreten von Nierentumoren mit einem schlechteren Gesamtüberle-ben vergesellschaftet [16,17,18]. Andere Untersuchungen zeigten z.…”

Nierenzellkarzinom

“…Im lokalisierten pT2-Stadium erfolgt nun erstmals eine Unterteilung der Tumoren in ein pT2a und pT2b mit einem Cutt-off der Tumorgröße von 10 cm, nachdem eine prognostische Unterscheidung innerhalb der T2-Gruppe anhand des Tumordurchmessers gezeigt wurde [19]. Im pT3a-Stadium wird weiterhin zwischen perirenaler und/oder peripelviner Fettgewebeinfiltration unterschieden [1].…”