AUA 2022: Oncologic Outcomes in Patients Diagnosed with pT3aN0M0 Renal Cell Cancer According to Renal Vein Thrombus or Fat Invasion

(UroToday.com) The 2022 American Urological Association (AUA) Annual Meeting included a session on advanced kidney cancer and a presentation by Dr. Giuseppe Basile discussing oncologic outcomes in patients diagnosed with pT3aN0M0 renal cell cancer according to renal vein thrombus or fat invasion. The natural history of patients with pT3a non-metastatic renal cell carcinoma (RCC) is extremely heterogeneous. After KEYNOTE 564 trial was published in The New England Journal of Medicine,1 such heterogeneity has special implications for follow-up schedule and enrollment in trial testing adjuvant agents. Thus, the aim of the study presented by Dr. Basile and colleagues was to investigate the differential prognosis of pT3a subtypes.


From a single institutional prospective database, 451 consecutive patients treated with radical nephrectomy for pT3aN0M0 RCC were selected. Patients were stratified according to pT3a subtype as (i) perirenal fat invasion only, (ii) sinus fat invasion only, (iii) segmental or renal vein thrombus only, or (iv) at least two of these features. Cancer specific survival (CSS), progression free survival (PFS, ie. only distant metastases), and relapse free survival (RSF, ie. local and/or distant progression) were analyzed with Cox regression models adjusted for tumor size, presence of necrosis and sarcomatoid features, and grade.

Overall, 67 (15%) patients presented with renal/segmental vein thrombus only, 185 (41%) with perirenal fat invasion, 101 (22%) with sinus fat invasion, and 98 (22%) with at least two of these features. At a median follow up of 5.4 years, 140 (31%) patients had distant progression, 18 (4%) local recurrence and 88 (20%) died due to RCC. The Kaplan Meier curves for CSS, PFS, and RFS according to presence of sinus fat invasion, perirenal fat invasion, or renal/segmental vein thrombus are as follows:

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The presence of at least two pT3a features was associated with a higher risk of progression (HR 2.20, 95% CI 1.21-3.98), recurrence (HR 2.26, 95% CI 1.26-4.08), and cancer specific mortality (HR 3.23, 95% CI 1.32-7.90) compared to the presence of only one pT3a feature. Furthermore, the presence of perirenal fat invasion was associated with a lower CSS (HR 2.64, 95% CI 1.11-6.25) compared to the presence of sinuous fat invasion or tumoral thrombus only.

Dr. Basile concluded his presentation discussing oncologic outcomes in patients diagnosed with pT3aN0M0 renal cell cancer according to renal vein thrombus or fat invasion with the following summary points:

  • The concurrent presence of perirenal and/or sinus fat invasion and/or renal/segmental thrombus determined a higher risk of progression, relapse, and cancer specific mortality
  • The presence of perirenal fat invasion also harbors slightly poorer outcomes relative to sinus fat invasion or tumoral thrombus only
  • These findings could improve candidate selection for adjuvant therapy

Presented by: Giuseppe Basile, MD, IRCCS Ospedale San Raffaele, Milan, Italy 

Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, @zklaassen_md on Twitter during the 2022 American Urological Association (AUA) Annual Meeting, New Orleans, LA, Fri, May 13 – Mon, May 16, 2022.

References:

  1. Choueiri TK, Tomczak P, Park SH, et al. Adjuvant Pembrolizumab after Nephrectomy in Renal-Cell Carcinoma. N Engl J Med. 2021 Aug 19;385(8):683-694.
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