PURPOSE: Tumor size and stage are important prognostic parameters in renal cell carcinoma.
While pathologic stage T1 and T2 are defined by size alone, presence of certain intrinsic features can upstage a tumor to pathologic stage T3a regardless of size. We investigate the effect of pathologic tumor stage on the relationship between tumor size and risk of disease recurrence.
MATERIALS AND METHODS: Data was reviewed on patients undergoing nephrectomy at our institution between 2006 and 2013 to identify all patients with pathologic stage T1, T2 and T3a tumors. A proportional hazards Cox model was built with time to recurrence as outcome, and pathologic stage and tumor size as covariates. An interaction for stage and tumor size was included.
RESULTS: The final cohort included 1,809 patients. On multivariable analysis, when adjusted for tumor size, patients with pT3a tumors had a greater risk of tumor recurrence compared to those with pT1/T2 tumors (HR 3.70, 95% CI 2.31, 5.92, p< 0.0001). The risk of disease recurrence increased more rapidly as tumor size increased only with the presence of perinephric fat invasion (p=0.006).
CONCLUSIONS: Using the AJCC 2010 staging criteria, we have validated pathologic stage T3a as a poor prognostic factor in renal cell carcinoma, regardless of tumor size. Our results also demonstrated an increased rate of risk for recurrence with perinephric fat invasion. Given this increased risk of recurrence, even in tumors less than 4 cm, closer surveillance is warranted in such patients and the role of perinephric involvement necessitates further investigation.
Written by:
Chevinsky M, Imnadze M, Sankin A, Winer A, Mano R, Jakubowski C, Mashni J, Sjoberg DD, Chen YB, Tickoo SK, Reuter VE, Hakimi AA, Russo P. Are you the author?
Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Surgical Pathology Diagnostic Service, Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Reference: J Urol. 2015 Feb 9. pii: S0022-5347(15)00251-7.
doi: 10.1016/j.juro.2015.02.013
PubMed Abstract
PMID: 25676433