Combined Renal Sinus Fat and Perinephric Fat Renal Cell Carcinoma Invasion Has a Worse Prognosis Than Either Alone

Kresowik, Timothy P.; Johnson, Matthew T.; Joudi, Fadi N.

doi:10.1016/j.juro.2010.03.010

Cited by 20 publications

(11 citation statements)

References 15 publications

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“…Contemporary series that investigate prognostic heterogeneity in the T3a-stage group lend further support to our assertion that the presence of multiple patterns of extrarenal extension portends poor prognosis. Similar to the present study, Kresowik et al [9] and Bedke et al [7] independently observed no difference in CSM between SF and PF infiltration, but a significantly increased risk of death in individuals harbouring both patterns of tumour extension. Similarly, Baccos et al [12] reported the combined involvement of RV and perirenal fat to be associated with a higher risk of CSM when compared to perirenal fat infiltration alone.…”

Section: Discussionsupporting

confidence: 91%

Prognostic evaluation of perinephric fat, renal sinus fat, and renal vein invasion for patients with pathological stage T3a clear‐cell renal cell carcinoma

et al. 2018

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The presence of multiple patterns of extrarenal extension is associated with a higher risk of disease progression and cancer-related death after radical nephrectomy compared to isolated involvement of the PF, renal SF, or RV, which carry similar prognostic weight. If validated, these findings may help refine risk stratification of non-metastatic T3a RCC by distinguishing patients with multiple vs one pattern of extrarenal extension.

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Section: Discussionsupporting

confidence: 91%

Prognostic evaluation of perinephric fat, renal sinus fat, and renal vein invasion for patients with pathological stage T3a clear‐cell renal cell carcinoma

et al. 2018

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“…Kresowik et al. [26] observed lower survival rates in those with concomitant SFI and PFI compared to SFI‐only and PFI‐only groups.…”

Section: Discussionmentioning

confidence: 98%

Impact of renal vein invasion and fat invasion in pT3a renal cell carcinoma

et al. 2011

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What ' s known on the subject? and What does the study add?The presence of invasion of renal vein and perinephric fat are predictors of poor outcome in patients with RCC. The latest version of the TNM system included tumours exhibiting such parameters in the T3a stage, thus grouping tumours with distinct pathologic features.Our study showed that patients with RCC presenting concomitant invasion of the renal vein invasion and perinephric fat invasion have signifi cantly worse survival rates than those showing any of the parameters separately. Therefore, we conclude that these tumours should not be grouped within T3a stage since they have signifi cantly different outcomes. OBJECTIVE• To evaluate the prognostic impact of tumor fat invasion (FI) and renal vein invasion (RVI) in patients with T3a renal cell carcinoma. PATIENTS AND METHODS• In total, 220 consecutive patients treated for renal cell carcinoma between 1992 and 2009 were analyzed. T3a stage cases were selected.• A single pathologist reviewed all cases. RESULTS• The present study cohort included 46 patients with mean follow-up of 28.6 months, of whom 17 (36.9%) died from disease. Patients were initially divided into three groups including 24 (52.1%) of FI only, 11 (23.9%) of RVI only and 11 (23.9%) of both FI and RVI.• In univariate analysis, no signifi cant differences in disease-specifi c survival (DSS) were noted between FI only and RVI only groups ( P = 0.91). DSS was signifi cantly worse in the FI + RVI group compared to the other groups ( P = 0.02).• When grouped into FI or RVI vs FI + RVI, DSS remained signifi cantly lower in the group containing the parameters concurrently ( P = 0.009). Progression-free survival also was signifi cantly lower in FI + RVI group ( P = 0.01).• Metastasis, positive lymph nodes and the presence of FI + RVI remained as isolated predictors of survival.• Patients with FI + RVI presented a 2.6-fold increase in risk of death from cancer and a 2.5-fold increase in risk of disease progression ( P = 0.04) compared to those with either of them alone. CONCLUSION• The isolated or concomitant presence of FI and RVI may be used as one of the criteria for staging in the next edition of the Tumour-Node-Metastasis classifi cation because they have signifi cantly different outcomes. KEYWORDSkidney , renal carcinoma , prognosis , oncology Study Type -Therapy (case series) Level of Evidence 4

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“…Furthermore, in the primary pT3a tumor staging system, different locations of the extra-renal extension were considered to be associated with a comparable prognosis. Several previous studies have investigated the effects of different sites of fat invasion on prognosis (3)(4)(5)(6)(7)(8) and shown that different locations of extrarenal invasion, including renal vein invasion (RVI), perirenal fat invasion (PFI), or perisinus fat invasion (PSI), do not differ significantly from one another with regards to the survival of patients with pT3a RCC. Actually, in our study, we also validated it, PFI alone and PSI alone showed comparable survival outcomes, therefore, merging these three isolated conditions into one stage seems reasonable.…”

Section: Introductionmentioning

confidence: 99%

Multiple Patterns of Perirenal Fat Invasion Are Associated With a Poorer Prognosis Compared With Isolated Invasion: A Proposal for a Revision of T3aN0M0 TNM Staging System

Wang

Zhu

et al. 2020

Front. Oncol.

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Objectives: Currently, renal cell carcinoma (RCC) presenting with perisinus fat invasion (PSI) and/or perinephric fat invasion (PFI) is merged as one entity, pathological T3a (pT3a); however, the combination of PFI and PSI (PFI+PSI) may not be associated with equivalent prognosis compared with either PFI or PSI alone (PFI/PSI). Here, we analyzed the prognostic significance of PFI+PSI vs. PFI/PSI in pT3aN0-1M0-1 RCC.Method: We identified 5,290 patients with pT3aN0-1M0-1 RCC, treated by nephrectomy, from the Surveillance, Epidemiology and End Results database, between 2010 and 2016. Cox proportional hazards regression and Fine and Gray competing risks regression were fitted to assess risks of survival outcomes, respectively. 1:1 propensity score method was used to minimize differences in the covariates' distributions.Results: Among all patients, 746 patients (14.1%), 2,569 patients (48.5%) and 1,975 patients (37.3%) experienced PFI+SI, PFI, and PSI, respectively, and 3,952 patients (74.7%) without diseases of lymphnode (N1) and/or distant metastasis (M1). PFI alone compared with PSI alone showed a comparable overall survival (OS) and cancer-special survival (CSS), either PFI or PSI alone experienced a better OS and CSS than PFI+PSI. In patients with pT3aN0M0 RCC, PFI+PSI compared with the PFI/PSI was significantly associated with worse OS with hazard ratio (HR) [95% confidence interval (CI)]: 1.38 [1.12-1.69], p = 0.002 and 1.41 [1.06-1.87], p = 0.017 for unmatched data and matched data, respectively, and higher RCC-special mortality (HR [95%CI]: 1.55 [1.21-1.99], p = 0.001 and 1.70 [1.19-2.43], p = 0.004 for unmatched data and matched data, respectively). However, in pT3aN1/M1 RCC patients, PFI+PSI was not significantly associated with RCC-special mortality (HR [95%CI]: 1.02 [0.85-1.23], p = 0.800 and 0.99 [0.79-1.24], p = 0.920 for unmatched data and matched data, respectively) in comparison with PFI/PSI. In addition, invasion type was not an independent risk factor for patient's prognostication in the pT3a RCC with diseases of N1 and/or M1 (all p > 0.5).Wang et al. Stage's Revision of Renal CancerConclusion: Multiple invasion patterns (PFI+PSI) are associated with inferior survival relative to PFI/PSI alone in patients with pT3aN0M0 RCC; however, these effects are masked in patients with metastatic disease. These results warrant consideration in the development of the next edition of the tumor-node-metastasis staging system, to improve risk stratification.

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Combined Renal Sinus Fat and Perinephric Fat Renal Cell Carcinoma Invasion Has a Worse Prognosis Than Either Alone

Abstract: Patients with combined renal sinus and perinephric fat invasion had a worse prognosis than those with either alone. Considerations should be made to stage these cases accordingly.

Cited by 20 publications

References 15 publications

Prognostic evaluation of perinephric fat, renal sinus fat, and renal vein invasion for patients with pathological stage T3a clear‐cell renal cell carcinoma

Prognostic evaluation of perinephric fat, renal sinus fat, and renal vein invasion for patients with pathological stage T3a clear‐cell renal cell carcinoma

Impact of renal vein invasion and fat invasion in pT3a renal cell carcinoma

Multiple Patterns of Perirenal Fat Invasion Are Associated With a Poorer Prognosis Compared With Isolated Invasion: A Proposal for a Revision of T3aN0M0 TNM Staging System

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