The prognostic value of the site of invasion in T3aN0M0 clear cell renal cell carcinoma

Guo, Shengjie; Liu, Zefu; Li, Xiangdong; Yao, Kai; Dong, Pei; Chen, Dong; Liao, Chunxian; Long, Zhaolin; Wang, Yongqiang; Zhou, Fangjian; He, Xiaobo; Liu, Zhuowei

doi:10.1016/j.urolonc.2019.01.019

Cited by 14 publications

(13 citation statements)

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“…The largest margin in terms of CSS was found between patients with combined PFI + SFI and additional RVI and patients with PFI alone without RVI (5-year CSS 57.5% vs. 89%, HR 4.01, p = 0.029). This observation is consistent with the studies by Guo et al and Shah et al, who showed a significantly worse prognosis for patients with combined PFI + SFI and RVI [17,18].…”

Section: Discussionsupporting

confidence: 93%

The prognostic value of fat invasion and tumor expansion in the hilar veins in pT3a renal cell carcinoma

et al. 2021

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Purpose The 7th TNM classification summarizes renal cell carcinoma (RCC) with perirenal (PFI) and/or sinus fat invasion (SFI) as well as hilar vein involvement (RVI) as pT3a tumors. In this study, we aimed to determine the prognostic value of fat invasion (FI) in the different compartments and RVI for medium-term cancer-specific-survival (CSS) in pT3a RCC. Materials and methods Patients with pT3a RCC were identified using an institutional database. All original pathological reports were reclassified according to the 7th TNM edition. The prognostic value of FI as well as divided into PFI, SFI, combined PFI + SFI, and RVI for CSS was assessed using univariate and multivariate Cox-regression analysis. Survival was estimated using the Kaplan–Meier method. Results Median follow-up in 184 pT3a tumors was 38 months. FI was detectable in 153 patients (32.7% PFI, 45.1% SFI, 22.2% PFI + SFI), 31 patients showed RVI alone. Combined PFI + SFI increased the risk of cancer-related death compared to PFI (HR 3.11, p < 0.01), SFI (HR 1.84, p = 0.023) or sole RVI (HR 2.12, p = 0.025). In multivariate analysis, a combined PFI + SFI vs. PFI or SFI as the only compartment involved was confirmed as independent prognostic factor (HR 1.83, p = 0.029). Patients with FI and simultaneous RVI had significantly shorter CSS (HR 2.63, p < 0.01). In an unweighted model, the difference between patients with combined PFI + SFI and RVI and those with PFI alone was highest (HR 4.01, p = 0.029). Conclusions These results underline the subdivision of pT3a RCC depending on the location of FI and RVI for patient stratification.

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Section: Discussionsupporting

confidence: 93%

The prognostic value of fat invasion and tumor expansion in the hilar veins in pT3a renal cell carcinoma

et al. 2021

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“…Furthermore, there is a trend of worse outcomes with tumor size increases from 0-4cm to 4-7cm and over 7 cm in pT3a RCC [10]. We previously showed that the PFI and SFI has similar prognosis, and single fat invasion site invasion has better survival than multiple sites invasion in pT3aN0M0 RCC [11]. There are also some studies showed that tumor grade and pathology type could affect the survival of pT3a RCC [12,13].…”

Section: Discussionmentioning

confidence: 97%

The Effectiveness of Partial Versus Radical Nephrectomy for pT3aN0M0 Renal Cell Carcinoma: A Propensity Score Analysis

Yang

Liu

et al. 2020

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Background The survival benefit of partial nephrectomy (PN) in pT3a RCC patients is controversial. Here we aimed to determine the benefit of PN for T3aN0M0 renal cell carcinoma (RCC). Methods Data of patients with pT3aN0M0 RCC who were diagnosed between 2010–2012 in the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database were retrospectively collected. We compared overall survival (OS) and cancer specific survival (CSS) using a Cox proportional hazards model between PN and radical nephrectomy (RN) in pT3aN0M0 RCC. Propensity score (–adjusted, –stratified, –weighted, and –matched) analyses were performed to control for imbalances in individual risk factors. Results A total of 1277 patients with pT3aN0M0 RCC were identified, of whom 200 patients were treated with PN and 1077 patients were RN. Patients who received PN were more likely to have small tumor size, well/moderately differentiation, peritumoral fat invasion, and less likely to have multiple site invasion and clear cell adenocarcinoma type (p < 0.05). PN showed favorable OS and CSS in 0-4cm pT3aN0M0 RCC (p < 0.05), and similar OS and CSS in 4-7cm pT3aN0M0 RCC, compared with RN using un-adjusted analyses. The Propensity score analyses further demonstrated the survival benefit of PN compared with the RN in 0-4cm pT3aN0M0 RCC (p < 0.05). Conclusions In this observational study, PN was associated with improved survival compared with RN in 0-4cm pT3aN0M0 RCC. Moreover, survival was comparable between PN and RN in 4-7cm pT3aN0M0 RCC. These data provided evidence that PN is an alternative choice for T3aN0M0 RCC less than 7 cm. Patients with 0-4cm pT3aN0M0 RCC may benefit from PN.

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“…Several studies have highlighted the impact of tumor size on CSS for T3a renal tumor (3,18,22,39,(44)(45)(46)(47)(48). In light of the agreement of some studies in which a cutoff of 7 cm was recommended as a prognosis prediction for T3a renal tumor and the applicability of the refinement for the current TNM classification, only the results that considered tumor diameter as a binary variable by using a cutoff of 7cm were merged in the current study.…”

Section: Discussionmentioning

confidence: 99%

Oncological Outcomes of Patients With Different Pathological Features of pT3a Renal Tumor: A Systematic Review and Quantitative Synthesis

et al. 2021

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PurposeTo identify the differences in oncological outcomes for patients with different pT3a renal tumor invasion patterns and pathological features.MethodsThe protocol of this study was registered on PROSPERO (CRD42021234475). Relevant studies were identified by searching the PubMed, Cochrane library, Embase, and Web of Science databases. Cancer-specific survival (CSS) was selected as the endpoint. Pooled hazard ratio (HR) and 95% confidence interval (CI) extracted from multivariate Cox models were evaluated to identify the hazard association.ResultsA total of 22 studies, which enrolled 12384 patients were included for quantitative synthesis. Sinus fat invasion (SFI) + perinephric fat invasion (PFI) was associated with inferior CSS compared to SFI only (p = 0.02). Comparable CSS was observed between SFI and PFI (p = 0.57). SFI ± PFI showed inferior CSS compared to PFI only (p = 0.0002). The presence of pelvicalyceal system invasion significantly increased the risk of cancer-specific mortality (p = 0.0005). Renal vein invasion (RVI) indicated poor oncological outcomes in terms of CSS (p = 0.002). The concomitant RVI and fat invasion (FI) significantly increased the risk of deterioration of CSS compared to RVI or FI (p < 0.0001). Multiple invasion patterns translated into a significantly decreased CSS (p < 0.0001). Aggressive tumor behavior, including lymph node involvement (p = 0.006), distant metastases (p < 0.00001), sarcomatoid differentiation (p < 0.0001), necrosis (p < 0.0001), Fuhrman grade III or IV (p < 0.0001), positive margin (p < 0.0001), and tumor size >7cm (p < 0.0001) were the predictors of inferior CSS. The lymphovascular invasion (p = 0.67) was indolent in terms of CSS.ConclusionThis study confirmed the heterogenicity of pT3a renal tumors. Multiple invasion patterns could translate into a significantly decreased CSS, and SFI should not be merged in the SFI + PFI group. The presence of PSI or RVI could significantly increase the risk of cancer-specific mortality. Lymph node involvement, distant metastases, sarcomatoid differentiation, necrosis, high Fuhrman grade, positive margin, and size >7cm were the predictors of inferior CSS. A precise-risk grade of CSS for different invasion patterns including comprehensive combinations may be useful for the further refinements of the TNM system.Systematic Review RegistrationThe current study was registered on PROSPERO, and the registration numbers is CRD42021234475.

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The prognostic value of the site of invasion in T3aN0M0 clear cell renal cell carcinoma

Cited by 14 publications

References 11 publications

The prognostic value of fat invasion and tumor expansion in the hilar veins in pT3a renal cell carcinoma

The prognostic value of fat invasion and tumor expansion in the hilar veins in pT3a renal cell carcinoma

The Effectiveness of Partial Versus Radical Nephrectomy for pT3aN0M0 Renal Cell Carcinoma: A Propensity Score Analysis

Oncological Outcomes of Patients With Different Pathological Features of pT3a Renal Tumor: A Systematic Review and Quantitative Synthesis

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