The Prognostic Factors for Patients with pT1a Renal Cell Carcinoma

Abstract

PurposeAlthough the prognosis of patients with pT1a stage renal cell carcinoma (RCC) is generally good, some of these patients show distant metastasis. In this study, we intended to identify the perioperative and pathologic prognostic factors for patients with pT1a stage RCC.Materials and MethodsA total of 93 patients who were diagnosed with pT1aN0M0 RCC between January 1995 and December 2004 were included. All the patients underwent radical (n=63, 67.7%) or partial (n=30, 32.3%) nephrectomy by a single surgeon. Preoperative data [age, sex, body mass index (BMI), and the presence of symptoms], follow-up duration, surgical methods, and pathological parameters (tumor size, tumor location, histologic type, Fuhrman's nuclear grade and the presence of microvascular invasion, hemorrhage, necrosis, calcification, and a cystic component in the tumor) were retrospectively analyzed to identify which of these were prognostic factors for pT1a RCC.ResultsThe patients' mean age was 55.0±11.4 years and the mean follow-up duration was 63.6±31.1 months. The 5-year cancer-specific survival rate and the 5-year recurrence- free survival rate were 100% and 88.1%, respectively. Nine patients (9.7%) showed distant metastasis, but local recurrence was not shown. Fuhrman's nuclear grade (p=0.040, OR=5.147), microvascular invasion (p=0.011, OR=13.500), and tumor necrosis (p<0.001, OR=26.000) had a significant impact on distant metastasis in the univariate analysis. The multivariate analysis subsequently showed that microvascular invasion (p=0.033, OR=17.947) and tumor necrosis (p=0.002, OR=15.922) were independent prognostic factors.ConclusionsMicrovascular invasion and tumor necrosis are the prognostic factors for patients with pT1a RCC.

Tumor necrosis is a strong predictor for recurrence in patients with pathological T1a renal cell carcinoma

“…In the present study, five of 133 patients with pT1aN0M0 RCC (3.8%) experienced tumor recurrence (median follow-up time, 57.8 months). In previous studies, the 5-year RFS rates were 88–93% in patients with pT1aN0M0 RCC ( 5 , 6 ). The 5-year RFS rate in our study was higher than that in the previous studies.…”

“…By contrast, there were no patients with bone recurrence in the present study. Kim et al reported that the lungs were the major site of recurrence in patients with pT1aN0M0RCC (four of nine patients), and only one patient had a recurrence in the bone ( 5 ). Therefore, it remains controversial whether the bone is a preferred site of recurrence in pT1aN0M0 RCC.…”

“…Two studies have evaluated the predictors for recurrence in patients with pT1a RCC ( 5 , 6 ). Kim et al ( 5 ) revealed that MVI and tumor necrosis were independent predictors for recurrence.…”

“…Two studies have evaluated the predictors for recurrence in patients with pT1a RCC ( 5 , 6 ). Kim et al ( 5 ) revealed that MVI and tumor necrosis were independent predictors for recurrence. Nishikimi et al ( 6 ) evaluated RCC patients with clear cell RCC using multivariate analysis and found that Fuhrman grade, growth pattern and tumor necrosis were significantly associated with disease-free survival.…”

“…As the majority of pT1a RCCs are less aggressive and recurrence is rare, longer follow-up intervals are generally accepted compared with RCCs at higher pathological stages ( 7 ). Kim et al ( 5 ) reported that 9 out of 93 pT1aN0M0 patients exhibited distant metastasis (mean follow-up duration, 63.6 months). Furthermore, Nishikimi et al ( 6 ) reported that 25 of 293 pT1aN0M0 patients exhibited distant metastasis (median follow-up duration, 62 months).…”