Nephron-Sparing Surgery for Adult Xp11.2 Translocation Renal Cell Carcinoma at Clinical T1 Stage: A Multicenter Study in China - Beyond the Abstract

As an aggressive tumor, adult Xp11.2 translocation renal cell carcinoma (RCC) tends to occur in local invasion and lymphatic metastasis even at an early stage, which makes it differ from conventional RCC subtypes, such as clear cell RCC, papillary RCC, and chromophobe RCC. Currently, nephron-sparing surgery (NSS) is more popular than radical nephrectomy (RN) in treating kidney tumors at T1a and selective T1b stage. Although NSS could resect primary kidney tumors completely as RN in most cases, the risk of surgical margin positivity, renal sinus invasion, and vascular invasion gives NSS more potency for recurrence. However, those risk factors are also ignored or undetected by radiological examination before the operation.

In this way, the current study divided adult Xp11.2 translocation RCCs into clinical T1a (cT1a) stage and clinical T1b (cT1b) stage basing on the preoperative CT imaging. As expected, results showed that surgical margin positivity and pelvicalyceal, vascular, and region lymphatic involvement were more likely to occur in the Xp11.2 translocation RCCs at cT1b stage (P<0.05). On the other hand, the anatomical feature, which not only determined the complexity of NSS but also reflected the aggressiveness and local invasiveness, was also evaluated. Compared with conventional RCC, a closer location of Xp11.2 translocation RCC to collecting system, sinus, and renal midline axial were observed in the set of cT1a group. Survival analyzed showed that patients with Xp11.2 translocation RCC of cT1b stage who underwent RN had a more favorable progression-free survival (PFS) than those who underwent NSS (P = 0.048). In conclusion, NSS should be performed with more deliberation in patients at least with cT1b tumors.

Written by: Ning Liu, MD, and Weidong Gan, MD, Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China

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