SIU 2017: Outcomes of Pathologic T3a Renal Cell Carcinoma Up-Staged from Small Renal Tumor: Emphasis on Partial Nephrectomy

Lisbon, Portugal ( The prognosis of pathologic T3a renal cell carcinoma (RCC) that is up-staged from a small renal tumor is controversial. The authors evaluated the prognosis of RCC patients who were postoperatively up-staged from clinical T1 to pathologic T3a.

Data of 3,431 patients surgically treated for clinical T1 RCC was retrospectively collected. The survival outcomes were compared using Kaplan-Meier and Cox proportional analyses.

Among the clinical T1 RCC patients, 215 (6.3%) were finally up-staged to pathologic T3a. Patient age (HR 1.030, 95% CI 1.018-1.046, p < 0,001), tumour diameter (HR 1.686, 95% CI 1.551–1.834, p< 0,001), and hilar location (HR 1.765, 95% CI 1.147– 2.715, p = 0.010) were significantly associated with up-staging in multivariable analysis. Kaplan-Meier analyses showed significantly poorer progression-free (PFS), cancer specific (CSS) and overall (OS) survivals (p < 0,001) in up-staged patients. Multivariable Cox regression analysis revealed pathologic up-staging as an independent predictor of inferior progression free survival (PFS) (HR 2.195, 95% CI 1.459-3.300, p< 0.001), CSS (HR 2.238, 95% CI 1252-4.003, p = 0.007), and overall survival (OS) (HR 1.632,95% CI 1,029-2.588, p = 0.037). Subgroup analysis of pathologic T3a showed that there was no significant difference in survival in the partial nephrectomy group compared with the radical nephrectomy group (all p > 0.5).

RCC patients up-staged from clinical T1 to pathologic T3a demonstrated worse postoperative outcomes than those without up-staging. However, partial nephrectomy, compared with radical nephrectomy, resulted in comparable outcomes in these upstaged patients.

Presented by: Young Ju Lee
Affiliation: Seoul National University Hospital, Seoul, South Korea

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre.Twitter: @GoldbergHanan at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal