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WCE 2017: Predicting Risk of Pathological Upstaging of Clinical T1 Renal Masses in the Era of Renal Mass Biopsy

Vancouver, Canada (UroToday.com) Smith et al. presented a retrospective study of 98,936 patients identified using the National Cancer Database (NCDB). The final analytical cohort included 6,409 patients who were initially diagnosed with cT1 renal cell carcinoma, treated with partial or radical nephrectomy from 2004-2013, and subsequently upstaged to pT3-4. 

On multivariate logistic regression analysis, a higher odds of upstaging was associated with age equal to or greater than 80 (OR 2.7, p < 0.001), non-Black race, male sex, cT1B (OR 3.3, p < 0.001), cN1 (OR 4.4, p < 0.001), collecting duct histology (OR 8.0, p < 0.001), Fuhrman grade III/IV, and the presence of sarcomatoid features (OR 2.8, p < 0.001). A nomogram was created using these predictors of upstaging with the most weight given to the histologic subtype.

Although renal mass biopsy remains controversial and underutilized, these authors deserve applause for developing a nomogram to use in conjunction with renal mass biopsy to assist in clinical decision-making. An important variable that should’ve been included in the multivariate model is the time from diagnosis to treatment, which is likely to impact the risk of upstaging.

Presented by: Zachary L. Smith

Authors: Zachary L. Smith, Scott Johnson, and Scott Eggener
Affiliaiton: The University of Chicago, Chicago, IL, USA

Written by: Michael Owyong (@ohyoungmike), LIFT Fellow, Department of Urology, UC Irvine Medical Center, Orange, CA at the 35th World Congress of Endourology– September 12-16, 2017, Vancouver, Canada.