Multi-Institutional Survival Analysis of Incidental Pathologic T3a Upstaging in Clinical T1 Renal Cell Carcinoma Following Partial Nephrectomy

To evaluate whether incidental pT3a upstaging after partial nephrectomy (PN) for cT1 disease results in inferior oncologic outcomes compared to pT1a/b disease.

Retrospective chart review was completed at the University of Michigan and Moffitt Cancer Center to identify patients undergoing PN for cT1 masses between 1995-2015.

A total of 1955 patients were identified, of which 95 had pT3a upstaging. Median follow-up was 38.2 months. Patients with pT3a disease were individually matched by clinico-pathologic features with patients undergoing PN with pT1a/b disease in a 1:2 ratio. Kaplan-Meier analysis and univariate/multivariable Cox proportional hazards regression analysis was performed. Primary endpoint was recurrence free survival (RFS). Secondary endpoints were all-cause mortality (OS), cancer-specific survival (CSS), and rates of local and distant recurrence.

Recurrence rates were significantly higher in pT3a disease compared to pT1a/b controls (p<0.01). In those with pT3a upstaging, 3- and 5-year RFS was 81% and 58%, compared to 86% and 75% in pT1a/b controls (p=0.01). 3- and 5-year CSS was 91% and 90% in pT3a disease and 100% and 97% in pT1a/b controls (p<0.01). OS at 3- and 5-years was 82% and 71% in pT3a disease and 93% and 80% in pT1a/b controls (p=0.04). Univariate/multivariable analysis of pT3a disease demonstrated no association between demographic or pathologic characteristics and RCC recurrence.

Patients with pT3a upstaging following PN experience a significantly reduced RFS and CSS when compared to pT1 disease.

Urology. 2018 Apr 17 [Epub ahead of print]

Christopher M Russell, Amir H Lebastchi, Juan Chipollini, Adam Niemann, Rohit Mehra, Todd M Morgan, David C Miller, Ganesh S Palapattu, Khaled S Hafez, Wade J Sexton, Philippe E Spiess, Alon Z Weizer

Department of Urology, University of Michigan, Ann Arbor, Michigan., Department of Urologic Oncology, Moffitt Cancer Center, Tampa, Florida., Department of Pathology, University of Michigan, Ann Arbor, Michigan., Department of Urology, University of Michigan, Ann Arbor, Michigan. Electronic address: .

Go Beyond the Abstract and Read a Commentary by Christopher Russell, MD, and Alon Weizer, MD, Department of Urology, University of Michigan, Ann Arbor, Michigan