This retrospective study evaluated pre-operative factors for pT3 upstaging in cT1 renal cell carcinoma (RCC). 181 patients were included in the analysis. The median patient age was 65 years. 126 patients (70%) had cT1a tumor and 55 (30%) had T1b. 8 cases (4.4%) were found to be pT3a upstaging; 5 cases had perirenal fatty tissue invasion, 2 cases had venous invasion, and 1 case had both renal sinus fatty tissue invasion and venous invasion. In univariate analysis, tumor diameter was more than 40mm, the distance between the tumor and the renal collecting system less than 4 mm, and a high level of preoperative plasma fibrinogen was associated with pT3 stage. Preoperative plasma fibrinogen level > 330 mg/dl was a significant independent factor predicting upstage (odds ratio = 4.75, p=0.041) in multivariate analysis. In previous studies, some preoperative factors, such as male sex, older age, large tumor diameter, and high R.E.N.A.L nephrometry score, were observed as predictive factors for pT3 upstaging.2-4 To our knowledge, this is the first report to predict pT3 upstaging in cT1 RCC using preoperative plasma fibrinogen.
Furthermore, we assessed the factors involved in the prognosis of cT1 RCC. Among patients with malignant disease (n = 162), during a median follow-up period of 44.8 months, patients with a preoperative plasma fibrinogen level ≧330 mg/dL were significantly worse than those with a preoperative plasma fibrinogen level <330 mg/dL in overall survival (p = 0.0002) and recurrence-free survival (p = 0.002). On the other hand, pT stage and tumor size were not correlated with prognoses. High levels of coagulation markers such as plasma fibrinogen are associated with poor oncological outcomes in several cancers, including RCC.5-6 Our study suggested that elevated fibrinogen levels were associated with an unfavorable prognosis in RCC patients, even in cases of early-stage cT1 tumors.
In summary, an elevated plasma fibrinogen level could serve as a potential biomarker to predict the upstaging of cT1 renal tumors to pT3 and might offer valuable insights for surgical decision-making. Patients with cT1 renal tumors with elevated plasma fibrinogen levels might have risks of unfavorable survival outcomes, so close monitoring should be considered. This study suggested the benefits of evaluating the preoperative plasma fibrinogen level to support the management of cT1 renal tumors.
Written by: Sho Sekito,1,2 Shiori Tanaka,1 Goshi Kitano,1 Manabu Kato,1 Yuji Ogura1 and Takahiro Kojima1
- Department of Urology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
- Department of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
- Nocera L, Stolzenbach LF, Ruvolo CC, et al. Predicting the risk of pT3a stage in cT1 clear cell renal cell carcinoma. European Journal of Surgical Oncology. 2021 May 1;47(5):1187–90.
- Teishima J, Hayashi T, Kitano H, et al. Impact of radiological morphology of clinical T1 renal cell carcinoma on the prediction of upstaging to pathological T3. Jpn J Clin Oncol. 2020 Apr 1;50(4):473–8.
- Gorin MA, Ball MW, Pierorazio PM, et al. Outcomes and predictors of clinical T1 to pathological T3a tumor up-staging after robotic partial nephrectomy: A multi-institutional analysis. Journal of Urology. 2013;190(5):1907–11.
- de la Barra CIC, González PG, Baeza MÁ, et al. A preoperative model to predict PT3 upstaging in clinically localized renal cell carcinoma. Cent European J Urol. 2020;73(2):173–7.
- Wang Z, Fan H, Wang W, et al. High preoperative plasma fibrinogen independently predicts a poor prognosis in patients with nonmetastatic RCC. J Cancer. 2020;11(9):2401–7.
- Sasaki T, Onishi T. Pretherapeutic plasma fibrinogen level is an independent survival predictor in renal cell carcinoma. Oncol Res Treat. 2015 Aug 20;38(7–8):374–8.