To determine whether clinical risk factors and morphometric features on pre-operative imaging can be utilized to identify those patients with cT1 tumors who are at higher risk of upstaging (pT3a).
A retrospective international case control study of consecutive patients treated surgically with radical or partial nephrectomy for non-metastatic RCC (cT1 N0) conducted between January 2010 and December 2018. Multivariable logistic regression models were used to study associations of pre-operative risk factors on pT3a pathological upstaging among all patients, as well as subsets with those with pre-operative tumors <4cm, renal nephrometry scores, tumors <4cm with nephrometry scores, and clear cell histology. We also examined association with pT3a subsets (renal vein, sinus fat, perinephric fat).Resultsand Limitations: Among the 4092 PN and 2056 RN patients, pathologic upstaging occurred in 4.9% and 23.3% patients, respectively. Among each group independent factors associated with pT3a upstaging were increasing preoperative tumor size, increasing age, and the presence of diabetes. Specifically, among PN subjects diabetes (odds ratio, OR =1.65; 95% CI 1.17,2.29), male sex (OR = 1.62; 95% CI 1.14,2.33), and increasing BMI (OR =1.03; 95%CI 1.00,1.05 per one unit BMI) were statistically associated with upstaging. Subset analyses identified hilar tumors as more likely to be upstaged (PN OR = 1.91; 95%CI 1.12,3.16 | RN OR = 2.16; 95% 1.44, 3.25).
Diabetes and higher BMI were associated with pathologic upstaging, as were preoperative tumor size, increased age, and male sex. Similarly, hilar tumors were frequently upstaged.
The Journal of urology. 2023 Aug 14 [Epub ahead of print]
Deepak K Pruthi, Gregor Miller, Donna P Ankerst, Matthias Neumair, Umberto Capitanio, Andres F Correa, Brian R Lane, Eduard Roussel, Thomas B McGregor, Ithaar H Derweesh, Mauricio Cordeiro, Phillip M Pierorazio, Carlos Calvo, Hai Bi, Sabrina L Noyes, Margaret Meagher, Alexander Kutikov, Robert G Uzzo, Hendrik Van Poppel, Alessandro Larcher, Francesco Montorsi, Michael W Kattan, Dharam Kaushik, Michael A Liss
University of Texas Health San Antonio, San Antonio, TX., Core Facility Statistical Consulting, Helmholtz München, Munich, Germany., Department of Mathematics, Technical University of Munich, Munich, Germany., Raffaele Department of Urology. Division of Experimental Oncology, Urological Research Institute, San Raffaele Hospital, Milan, Italy., Fox Chase Cancer Center, Philadelphia, PA., Spectrum Health Cancer Center, Grand Rapids, MI., Katholieke Universiteit Leuven, Leuven, Belgium., Department of Urology, Dalhousie University, Halifax, Canada., University of California San Diego, La Jolla, CA., Universidade de Sao Paolo, Sao Paolo, Brazil., Penn Presbyterian Medical Center, University of Pennsylvania., Pontificia Universidad Catolica de Chile, Santiago, Chile., Department of Urology, Peking University Third Hospital, Beijing, China., Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH.