Significance of Pathologic T3a Upstaging in Clinical T1 Renal Masses Undergoing Nephrectomy

Ramaswamy, Krishna; Kheterpal, Emil; Pham, Hien; Mohan, Sanjay; Stifelman, Michael; Taneja, Samir S.; Huang, William C.

doi:10.1016/j.clgc.2015.01.001

Cited by 49 publications

(39 citation statements)

References 17 publications

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“…Furthermore, Ramaswamy et al reported that the oncological outcomes of pT3a upstaging from cT1 were good, because they did not observe recurrence in 66 patients with pT3a upstaging during a median follow-up of 50 months [13]. …”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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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.

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Section: Discussionmentioning

confidence: 99%

“…In addition, Ramaswamy et al demonstrated that upstaging was associated with clear cell histology, a tumor size of >4 cm, and positive surgical margins [13]. Moreover, Tay et al found that high RENAL nephrometry scores were a risk factor for upstaging, although age and Fuhrman grade were not significant risk factors [25].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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“…It has to be acknowledged that we relied on pathological rather than clinical T-stage information, which might be considered the main driver for operative decision-making. According to a recent study, significant pathological upstaging occurs in only 13% of cases, which might have not substantially altered the trends of utilization in our cohort [30]. Furthermore, clinical and pathologic outcomes have been previously shown to be highly correlated, thus making it unlikely to have introduced major bias in treatment decisions [31].…”

Section: Discussionmentioning

confidence: 99%

The Adoption of Nephron-Sparing Surgery in Europe - A Trend Analysis in Two Referral Centers from Austria and Germany

Meyer

Hansen²,

Becker³

et al. 2015

Urol Int

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Objective: To compare the trends of partial nephrectomy (PN) and radical nephrectomy (RN) in 2 European tertiary referral centers with regards to guideline changes. Materials and Methods: A total of 1,573 patients who underwent RN or PN for localized (≤T2) renal cell carcinoma (RCC) were included. Logistic regression analyses assessed the predictors of PN and laparoscopy over time. Results: Out of the total, 1,013 patients (65.6%) were treated with RN and 560 patients (34.4 %) with PN. Also, 1,233 patients (80%) had open surgery whereas 340 patients (22%) were treated with a laparoscopic approach. Laparoscopic RN and PN were performed in 216 (13.7%) and 124 (7.8%) patients, respectively. T1b tumors were 73% less likely (p < 0.001) to be treated with PN compared to T1a tumors. The odds of undergoing PN or laparoscopy in 2008-2010 relative to 2000-2001 were 6.5-fold (p < 0.001) and 36-fold higher (p < 0.001), respectively. Conclusions: Tumor size and year of surgery are independent predictors of PN in our cohort. Our data exemplify the adoption of PN for RCC in tertiary care centers in Austria and Germany in line with implemented guideline changes. The utilization of PN has increased over time regardless of surgical approach. Further studies need to address the use of robot-assisted surgery and care in community hospitals.

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“…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.…”

Section: Discussionmentioning

confidence: 96%

“…Previous literature offers conflicting results regarding the prognosis and associated factors for pT3a upstaging (6)(7)(8)(9)(10). Therefore, the objective of the present study was to evaluate the oncologic outcomes of the patients with pT3a upstaging tumors, and also to identify the clinicopathological features associated with upstaging.…”

mentioning

confidence: 97%

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

Lai

Wang

et al. 2020

In Vivo

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Aim: To evaluate the oncological outcomes of pathological T3a upstaging from clinical T1 renal cell carcinoma. Patients and Methods: We retrospectively studied patients who underwent radical or partial nephrectomy for clinical T1 renal tumors. Results: The median follow-up period was 44 months. At three and five years, the respective overall survival rate was 88. 7% and 82.4% in pT3a disease, 95.7% and 93.4% in pT1 (p=0.008), the cancer-specific survival rate, 93.9% and 90.8% in pT3a, 99% and 97.7% in pT1 (p=0.001), and the recurrence-free survival rate, 79.7% and 71.0% in pT3a, and 95.5 and 94.3% in pT1 (p<0.001). Conclusion: Patients with pathological T3a upstaging tumors were associated with a significantly decreased survival rate, along with a higher recurrence rate when compared to those with pathological T1 disease. 799Lai et al: Survival Αnalysis of Upstaging pT3a RCC

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Significance of Pathologic T3a Upstaging in Clinical T1 Renal Masses Undergoing Nephrectomy

Cited by 49 publications

References 17 publications

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

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

The Adoption of Nephron-Sparing Surgery in Europe - A Trend Analysis in Two Referral Centers from Austria and Germany

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

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