The Difference in Prognosis between Renal Sinus Fat and Perinephric Fat Invasion for pT3a Renal Cell Carcinoma: A Meta-Analysis

Zhang, Zhiling; Yu, Chunping; Velet, Liliya; Li, Yonghong; Jiang, Lijuan; Zhou, Fangjian

doi:10.1371/journal.pone.0149420

Cited by 27 publications

(19 citation statements)

References 19 publications

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“…However, there was no difference of sinus fat invasion between these two groups, which may attribute to the small percentage of sinus fat invasion in our data (6.7%). The survival analysis further showed that sinus fat infiltration did not influence the prognosis of pT3aN0M0 RCC, whereas this finding was different from the conclusion from a recent meta-analysis [ 15 ]. Hence, more studies with larger samples are required in future to answer this conflicting question.…”

Section: Discussioncontrasting

confidence: 91%

Influence of tumor size on oncological outcomes of pathological T3aN0M0 renal cell carcinoma treated by radical nephrectomy

Chen

et al. 2017

PLoS ONE

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ObjectiveTo evaluate the prognostic significance of tumor size in pathological T3aN0M0 renal cell carcinoma (RCC) treated by radical nephrectomy.Materials and methodsPatients who underwent radical nephrectomy for sporadic RCC with pathological T3aN0M0 RCC at our institution between January 2006 and June 2015 were identified. The entire cohort was divided into two groups according to the cutoff of tumor size obtained from receiver operating characteristic (ROC) curve. Clinicopathological variables were retrospectively collected and compared. Kaplan-Meier analysis and multivariate Cox regression were conducted to evaluate the effect of tumor size on survival outcomes.Results163 pT3aN0M0 RCC patients were included with a median follow-up period of 31 months. The optimal cutoff for tumor size was 7 cm according to the ROC curve. 90 cases (55.2%) presented tumors which measured 7 cm or less, and 73 cases (44.8%) showed tumor size greater than 7 cm. Patients with larger tumors tended to exhibit higher rates of symptoms and higher Fuhrman grades; they also indicated more necrosis features, and were more likely to invade the collecting system and renal vein. Compared with patients who exhibited tumor size of≤7 cm, those with tumor size>7 cm were associated with shorter estimated five-year cancer-specific survival (CSS, 46.6% versus 75.0%, P = 0.003) and five-year recurrence-free survival (RFS, 35.6% versus 62.7%, P = 0.011). Multivariate Cox analysis revealed that tumor size was retained as an independent factor for CSS (HR = 2.506, 95% CI 1.169–5.373, P = 0.018).ConclusionsThe tumor size significantly affected the survival outcomes of pT3aN0M0 RCC treated by radical nephrectomy, and a cutoff size of 7 cm can help enhance the prognostic discrimination. Thus, the tumor size may be considered in the future TNM classification of stage pT3a.

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Section: Discussioncontrasting

confidence: 91%

Influence of tumor size on oncological outcomes of pathological T3aN0M0 renal cell carcinoma treated by radical nephrectomy

Chen

et al. 2017

PLoS ONE

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“…Oncological outcomes associated with RSI have been reported previously in a meta-analysis that compared the cancer-specific survival (CSS) of patients with RSI and PNI across 6 studies comprising 1301 cases of T3a tumors. In that analysis, patients with RSI had significantly poorer CSS than those with PNI [ 14 ]. In addition, Timothy et al [ 15 ] indicated that the combination of RSI plus PNI resulted in significantly poorer CSS than either RSI or PNI alone.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with postoperative renal sinus invasion and perinephric fat invasion in renal cell cancer: treatment planning implications

et al. 2017

Oncotarget

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In patients with renal cell carcinoma (RCC), postoperative upstaging including perinephric fat invasion (PNI) and renal sinus invasion (RSI) leads to unfavorable oncological outcomes. Determining the preoperative risk factors for postoperative upstaging could be beneficial for treatment planning. In this study, 267 RCC patients who underwent radical nephrectomy were studied retrospectively. The RSI incidence was significantly greater than that of PNI. Kaplan-Meier analysis revealed that patients with RSI, PNI, and RSI plus PNI had poorer disease-free-survival than those with neither RSI nor PNI. Univariate and multivariate logistic regression analyses indicated that a tumor extension into the sinus, an irregular tumor-sinus border, and an irregular tumor shape in CT/MRI imaging were independent risk factors for RSI. And a tumor larger than 5 cm, an irregular tumor-perinephric fat border, and a tumor necrosis were independent risk factors for PNI. Subgrouping of patients into low-, moderate-, and high-risk groups according to these factors, revealed a direct association between the risk factors and PNI/RSI incidence. In conclusion, in patients with RCC, preoperative risk factors associated with postoperative upstaging could be assessed by imaging data obtained using CT or MRI. Preoperative Risk group classification would be clinically useful for patient counseling and treatment planning.

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“…However, there are still controversies with regard to the prognosis of patients with T3a RCC. An increasing number of studies have reported that patients with stage T3a RCC and SFI have a significantly worse prognosis compared with those with PFI (6)(7)(8). By contrast, other studies have suggested no significant differences in survival rates between patients with the two types of T3a RCC (9,10).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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In the current Tumor-Node-Metastasis (TNM) classification system for renal cell carcinoma (RCC), both perinephric fat invasion (PFI) and renal sinus fat invasion (SFI) are classified at the T3a stage. However, their associated prognoses are clinically controversial. The present study proposes a new sub-classification criterion for pathological T3a (pT3a) RCC with SFI or PFI to resolve this dispute. Data were collected from consecutive records of 2,765 patients with T1a renal cancer, who had undergone partial nephrectomy (PN) between 2001 and 2015 at one of four hospitals. Among these patients, 127 cases were diagnosed with stage pT3a RCC with SFI or PFI, according to final pathological examination. The pathological characteristics, clinical data and follow-up observations were analyzed. Of the 127 patients, with an average follow-up duration of 56 months (range, 15-60 months), 17 cases of tumor recurrence were found. After analysis of the pathological findings, the following new sub-classification criteria was proposed for pT3a RCC with SFI or PFI: i) Type A, renal tumor invades the pseudo-capsule and contacts with the perinephric adipose tissues directly (3 recurrences out of 57 patients); ii) type B, tumor protrudes into the perinephric adipose tissues like a tongue (4 recurrences out of 29 patients); and iii) type C, tumor nodules distribute in perinephric adipose tissues (10 recurrences out of 41 patients). There was statistically significant difference between the three subtypes in terms of recurrence rate (P= 0.023). In conclusion, controversies remain in the current TNM classification system for pT3a RCC. The present study added to the available data and found that pT3a RCC with tumor nodules in perinephric adipose or/and with an irregular tumor protruding into adipose tissues showed a higher recurrence rate. Thus, it is recommended that pT3a RCC should be carefully analyzed and should be considered differently to other stages of RCC.

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The Difference in Prognosis between Renal Sinus Fat and Perinephric Fat Invasion for pT3a Renal Cell Carcinoma: A Meta-Analysis

Cited by 27 publications

References 19 publications

Influence of tumor size on oncological outcomes of pathological T3aN0M0 renal cell carcinoma treated by radical nephrectomy

Influence of tumor size on oncological outcomes of pathological T3aN0M0 renal cell carcinoma treated by radical nephrectomy

Factors associated with postoperative renal sinus invasion and perinephric fat invasion in renal cell cancer: treatment planning implications

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

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