Tumor size and Fuhrman grade further enhance the prognostic impact of perinephric fat invasion and renal vein extension in T3a staging of renal cell carcinoma

被引:16
作者
Chen, Kenneth [1 ]
Lee, Bing Long [2 ]
Huang, Hong Hong [1 ]
Tan, Benjamin Yongcheng [3 ]
Lee, Lui Shiong [1 ]
Ng, Lay Guat [1 ]
Lau, Weber [1 ]
Yuen, John Shyi Peng [1 ]
机构
[1] Natl Univ Singapore, Dept Urol, Singapore Gen Hosp, Singapore, Singapore
[2] Natl Univ Singapore, Yong Loo Lin Sch Med, Singapore, Singapore
[3] Singapore Gen Hosp, Dept Pathol, Singapore, Singapore
关键词
disease-free survival; perinephric fat invasion; renal cell carcinoma; renal vein invasion; staging; CORTICAL TUMORS; CLASSIFICATION; SINUS; INFILTRATION; SURVIVAL; CANCER; REEVALUATION; RECURRENCE; THROMBOSIS; PROPOSAL;
D O I
10.1111/iju.13237
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Objective: To evaluate the prognostic values of perinephric fat invasion and renal vein invasion in pT3a renal cell carcinoma, as stand-alone factors and in combination with tumor size and Fuhrman grade. Methods: Survival data of pT1 and pT2 renal cell carcinomas were analyzed alongside pT3a tumors of similar size bands (pT1 vs pT3a <7 cm, pT2 vs pT3a >7 cm). Patients with adjuvant therapy, positive surgical margins, metastasis or pT3b-pT4 tumors were excluded. Results: No significant baseline demographic differences existed between the groups. Patients with renal vein invasion had larger tumors (median, 7.2 +/- 3.0 cm vs 5.5 +/- 3.6 cm, P = 0.039), and were more symptomatic (90.0% vs 61.7%, P = 0.028) compared with patients with perinephric fat invasion alone. Patients with perinephric fat invasion alone appeared to have better disease-free survival compared with those with renal vein invasion (P = 0.009). Having both perinephric fat invasion and renal vein invasion did not result in a poorer disease-free survival. pT3a (perinephric fat invasion) tumors <4cm and 4-7cm have significantly worse disease-free survival compared with pT1a and pT1b tumors (P < 0.001). Similarly, pT3a (perinephric fat invasion) tumors measuring >= 7 show a trend of poorer disease-free survival compared with pT2a and pT2b tumors (P = 0.267). Disease-free survival correlated with Fuhrman grading for patients with perinephric fat invasion (P = 0.008). In multivariate analysis, the survival curve of pT3a perinephric fat invasion group closely approximates that of pT2 group, whereas survival of the renal vein invasion group was significantly worse than the pT2 and perinephric fat invasion groups (P = 0.001). Conclusion: pT3a tumors with perinephric fat invasion appear to have better prognosis than those with renal vein invasion. Further stratification of pT3a renal cell carcinomas with regard to tumor size and Fuhrman grade further enhances the prognostic value in this group.
引用
收藏
页码:51 / 58
页数:8
相关论文
共 26 条
[1]   Differing Risk of Cancer Death Among Patients With Pathologic T3a Renal Cell Carcinoma: Identification of Risk Categories According to Fat Infiltration and Renal Vein Thrombosis [J].
Baccos, Alessandro ;
Brunocilla, Eugenio ;
Schiavina, Riccardo ;
Borghesi, Marco ;
Rocca, Giovanni Christian ;
Chessa, Francesco ;
Saraceni, Giacomo ;
Fiorentino, Michelangelo ;
Martorana, Giuseppe .
CLINICAL GENITOURINARY CANCER, 2013, 11 (04) :451-457
[2]   The extent of tumour fat invasion affects survival in patients with renal cell carcinoma and venous tumour thrombosis [J].
Bertini, Roberto ;
Roscigno, Marco ;
Freschi, Massimo ;
Angiolilli, Diego ;
Strada, Elena ;
Petralia, Giovanni ;
Sozzi, Francesco ;
Capitanio, Umberto ;
Cremonini, Anna ;
Rigatti, Patrizio .
BJU INTERNATIONAL, 2011, 108 (06) :820-824
[3]   Reacting to Changes in Staging Designations in the 7th Edition of the AJCC Staging Manual [J].
Boffa, Daniel J. ;
Greene, Frederick L. .
ANNALS OF SURGICAL ONCOLOGY, 2011, 18 (01) :1-3
[4]   Renal lymphatics, and lymphatic involvement in sinus vein invasive (pT3b) clear cell renal cell carcinoma: a study of 40 cases [J].
Bonsib, SM .
MODERN PATHOLOGY, 2006, 19 (05) :746-753
[5]   The renal sinus is the principal invasive pathway - A prospective study of 100 renal cell carcinomas [J].
Bonsib, SM .
AMERICAN JOURNAL OF SURGICAL PATHOLOGY, 2004, 28 (12) :1594-1600
[6]   Impact of renal vein invasion and fat invasion in pT3a renal cell carcinoma [J].
da Costa, Walter Henriques ;
Moniz, Ravendra R. ;
da Cunha, Isabela Werneck ;
Fonseca, Francisco Paulo ;
Guimaraes, Gustavo Cardoso ;
Zequi, Stenio de Cassio .
BJU INTERNATIONAL, 2012, 109 (04) :544-548
[7]   The American Joint Committee on Cancer: the 7th Edition of the AJCC Cancer Staging Manual and the Future of TNM [J].
Edge, Stephen B. ;
Compton, Carolyn C. .
ANNALS OF SURGICAL ONCOLOGY, 2010, 17 (06) :1471-1474
[8]   Independent validation of the 2002 American Joint Committee on cancer primary tumor classification for renal cell carcinoma using a large, single institution cohort [J].
Frank, I ;
Blute, ML ;
Leibovich, BC ;
Cheville, JC ;
Lohse, CM ;
Zincke, H .
JOURNAL OF UROLOGY, 2005, 173 (06) :1889-1892
[9]   pT2 classification for renal cell carcinoma. Can its accuracy be improved? [J].
Frank, I ;
Blute, ML ;
Leibovich, BC ;
Cheville, JC ;
Lohse, CM ;
Kwon, ED ;
Zincke, H .
JOURNAL OF UROLOGY, 2005, 173 (02) :380-384
[10]   Reevaluation of TNM staging of renal cortical tumors: Recurrence and survival for T1N0M0 and T3aN0M0 tumors are equivalent [J].
Gilbert, Scott M. ;
Murphy, Alana M. ;
Katz, Aaron E. ;
Goluboff, Erik T. ;
Sawczuk, Ihor S. ;
Olsson, Carl A. ;
Benson, Mitchell C. ;
McKiernan, James M. .
UROLOGY, 2006, 68 (02) :287-291