Prognostic heterogeneity in T3aN0M0 renal cell carcinoma according to the site of invasion

Park, Myungchan; Shim, Myungsun; Kim, Myong; Song, Cheryn; Kim, Choung‐Soo; Ahn, Hanjong

doi:10.1016/j.urolonc.2016.05.019

Cited by 27 publications

(24 citation statements)

References 25 publications

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“… 18 confirmed these results by analyzing 419 patients treated for pT3a stage RCC; poorer survival rates were observed in patients with EFI + RVI compared to patients with either pathology alone. Our results indicate a significant difference in RFS among groups A (single pathology) and B (both pathologies), however we did not observe a significant difference among the CSS of the two groups The difference between our study and previous studies is that we excluded patients who had lymph node invasion (LNI) 10 , 16 . The previous study showed that patients who had EFI and RVI had higher rates of LNI.…”

Section: Discussioncontrasting

confidence: 86%

“…According to the current TNM staging system, EFI and RVI can each lead to inclusion in same stage – (T3a) regardless of whether one or both of these pathologies (EFI or RVI) are present. However, several previous studies have shown that patients with EFI and RVI had poorer outcomes than those with only one (EFI or RVI) 10 , 16 – 18 . A recent European multi-center study 17 , validated the latest edition of the TNM (2009), evaluating 503 cases of T3a stage RCC and noting significantly lower survival rates in patients with concomitant EFI and RVI vs those with the single pathologies.…”

Section: Discussionmentioning

confidence: 92%

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Accurate Risk Assessment of Patients with Pathologic T3aN0M0 Renal Cell Carcinoma

Lee

Song

et al. 2018

Sci Rep

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To develop a more precise risk-stratification system by investigating the prognostic impact of tumor growth within fatty tissues surrounding the kidney and/or renal vein. We conducted a retrospective review of the medical records of 211 patients with a pathologic diagnosis of T3aN0M0RCC among 4,483 renal cell carcinoma (RCC) patients from February 1988 to December 2015 according to the number of T3a pathologies—extrarenal fat invasion (EFI) and/or renal venous invasion (RVI). During a mean follow-up duration of 38.8 months, the patients with both pathologies (EFI + RVI) had lower recurrence free survival (RFS) rate than those with only a single pathology (p = 0.001). Using multivariable Cox regression analysis, the presence of both factors was shown to be an independent predictor of RFS (HR = 1.964, p = 0.032); cancer specific survival rate was not different among patients with EFI and/or RVI. Patients with pathologic T3aN0M0 RCC presenting with both EFI and RVI were at an increased risk of recurrence following nephrectomy. Therefore, pathologic T3a RCC could be sub-divided into those with favorable and unfavorable disease according to presence of EFI and/or RVI pathologies.

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Section: Discussioncontrasting

confidence: 86%

Section: Discussionmentioning

confidence: 92%

Accurate Risk Assessment of Patients with Pathologic T3aN0M0 Renal Cell Carcinoma

Lee

Song

et al. 2018

Sci Rep

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“…In the current TNM staging system, the classification of pT3a only includes tumors extending into the renal vein or its branches; microscopic wall involvement is not mentioned in this particular category. Notably, Park et al (18) found that pT3aN0M0 patients who presented with RVI had a significantly worse prognosis than those with fat invasion; the 5-year recurrence-free survival and 5-year DSS for RVI/RVI+PFI±PSI vs. PFI alone/PSI alone/PFI+PSI were 33.8 vs. 67.9% (p < 0.001) and 63.0 vs. 88.2% (p < 0.001), respectively. However, it is important to note that in the RVI/RVI+PFI±PSI group, 52.1% of patients presented with vein-wall invasion and that renal vein-wall involvement was a good predictor of a poor prognosis.…”

Section: Discussionmentioning

confidence: 99%

Multiple Patterns of Perirenal Fat Invasion Are Associated With a Poorer Prognosis Compared With Isolated Invasion: A Proposal for a Revision of T3aN0M0 TNM Staging System

Wang

Zhu

et al. 2020

Front. Oncol.

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Objectives: Currently, renal cell carcinoma (RCC) presenting with perisinus fat invasion (PSI) and/or perinephric fat invasion (PFI) is merged as one entity, pathological T3a (pT3a); however, the combination of PFI and PSI (PFI+PSI) may not be associated with equivalent prognosis compared with either PFI or PSI alone (PFI/PSI). Here, we analyzed the prognostic significance of PFI+PSI vs. PFI/PSI in pT3aN0-1M0-1 RCC.Method: We identified 5,290 patients with pT3aN0-1M0-1 RCC, treated by nephrectomy, from the Surveillance, Epidemiology and End Results database, between 2010 and 2016. Cox proportional hazards regression and Fine and Gray competing risks regression were fitted to assess risks of survival outcomes, respectively. 1:1 propensity score method was used to minimize differences in the covariates' distributions.Results: Among all patients, 746 patients (14.1%), 2,569 patients (48.5%) and 1,975 patients (37.3%) experienced PFI+SI, PFI, and PSI, respectively, and 3,952 patients (74.7%) without diseases of lymphnode (N1) and/or distant metastasis (M1). PFI alone compared with PSI alone showed a comparable overall survival (OS) and cancer-special survival (CSS), either PFI or PSI alone experienced a better OS and CSS than PFI+PSI. In patients with pT3aN0M0 RCC, PFI+PSI compared with the PFI/PSI was significantly associated with worse OS with hazard ratio (HR) [95% confidence interval (CI)]: 1.38 [1.12-1.69], p = 0.002 and 1.41 [1.06-1.87], p = 0.017 for unmatched data and matched data, respectively, and higher RCC-special mortality (HR [95%CI]: 1.55 [1.21-1.99], p = 0.001 and 1.70 [1.19-2.43], p = 0.004 for unmatched data and matched data, respectively). However, in pT3aN1/M1 RCC patients, PFI+PSI was not significantly associated with RCC-special mortality (HR [95%CI]: 1.02 [0.85-1.23], p = 0.800 and 0.99 [0.79-1.24], p = 0.920 for unmatched data and matched data, respectively) in comparison with PFI/PSI. In addition, invasion type was not an independent risk factor for patient's prognostication in the pT3a RCC with diseases of N1 and/or M1 (all p > 0.5).Wang et al. Stage's Revision of Renal CancerConclusion: Multiple invasion patterns (PFI+PSI) are associated with inferior survival relative to PFI/PSI alone in patients with pT3aN0M0 RCC; however, these effects are masked in patients with metastatic disease. These results warrant consideration in the development of the next edition of the tumor-node-metastasis staging system, to improve risk stratification.

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“…Multivariable* HR (95% CI) HR (95% CI) Progression, P < 0.001 Progression, P = 0.020 In contrast to our present results, several studies report prognostic differences between various sites of extrarenal extension. Particularly notable is a recent study by Park et al [8] who, despite reporting worse survival outcomes for combined RV and perirenal fat infiltration, also note increased CSM in the setting of isolated RV tumour thrombus vs isolated perirenal fat involvement. This discrepancy with our present study findings may be explained by their inclusion of a substantial number of cases with microscopic tumour invasion of the RV wall.…”

Section: Univariablementioning

confidence: 99%

Prognostic evaluation of perinephric fat, renal sinus fat, and renal vein invasion for patients with pathological stage T3a clear‐cell renal cell carcinoma

et al. 2018

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The presence of multiple patterns of extrarenal extension is associated with a higher risk of disease progression and cancer-related death after radical nephrectomy compared to isolated involvement of the PF, renal SF, or RV, which carry similar prognostic weight. If validated, these findings may help refine risk stratification of non-metastatic T3a RCC by distinguishing patients with multiple vs one pattern of extrarenal extension.

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Prognostic heterogeneity in T3aN0M0 renal cell carcinoma according to the site of invasion

Cited by 27 publications

References 25 publications

Accurate Risk Assessment of Patients with Pathologic T3aN0M0 Renal Cell Carcinoma

Accurate Risk Assessment of Patients with Pathologic T3aN0M0 Renal Cell Carcinoma

Multiple Patterns of Perirenal Fat Invasion Are Associated With a Poorer Prognosis Compared With Isolated Invasion: A Proposal for a Revision of T3aN0M0 TNM Staging System

Prognostic evaluation of perinephric fat, renal sinus fat, and renal vein invasion for patients with pathological stage T3a clear‐cell renal cell carcinoma

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