Does the Unexpected Presence of Non-organ-confined Disease at Final Pathology Undermine Cancer Control in Patients with Clinical T1N0M0 Renal Cell Carcinoma Who Underwent Partial Nephrectomy?

Capitanio, Umberto; Stewart, Grant D.; Klatte, Tobias; Akdoğan, Bülent; Roscigno, Marco; Marszalek, Martin; Dell’Oglio, Paolo; Zaffuto, Emanuele; Faba, Ó. Rodríguez; Salagierski, Maciej; Lingard, James; Carini, Marco; Ouzaïd, I.; Mir, Maria Carmen; Montorsi, Francesco; Pozzo, L. Da; Stief, Christian G.; Minervini, Andrea; Brookman‐May, Sabine

doi:10.1016/j.euf.2017.02.020

Cited by 13 publications

(9 citation statements)

References 21 publications

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“…Jeong et al [2] found that surgical technique (PN or RN) did not affect the recurrence rate for cT1 RCC upstaged to pT3a. Capitanio et al [26] also reported no difference in terms of metastatic PFS and CSS between PN and RN cohorts in patients upstaged to pathological T3a RCC disease. They concluded that cancer control is similar between patients treated with an extirpation of the entire kidney and those with partial resection, even if the final histopathological examination demonstrated a tumor that was unexpectedly upstaged from clinical T1 to pathological T3a.…”

Section: Discussionmentioning

confidence: 99%

The Preoperative Predictive Factors for Pathological T3a Upstaging of Clinical T1 Renal Cell Carcinoma

et al. 2019

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We aimed to determine the oncological outcomes of patients with clinical T1 renal cell carcinoma (RCC) upstaged to pathological T3a and to identify the preoperative predictive factors for upstaging. We retrospectively reviewed 272 patients with clinical T1 RCC who underwent surgical treatment. Thirty-three patients (12%) were upstaged to pathological T3a. These patients had a significantly larger tumor size on computed tomography (p < 0.0001), a higher aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (p = 0.037), and an elevated c-reactive protein (CRP) level (p = 0.014) preoperatively compared with those with pathological T1 RCC. On multivariate analysis, tumor diameter was the only significant preoperative predictive factor for upstaging [hazard ratio (HR), 3.61; 95% confidence interval (CI), 1.32–9.84; p = 0.01]. The AST/ALT ratio tended to be a preoperative predictive factor for upstaging, although it was not significant (HR, 2.14; 95% CI, 0.97–4.73; p = 0.06). Pathological T3a upstaging occurred in 25% of those with a tumor diameter ≥30 mm and a preoperative AST/ALT ratio ≥1.1. There was a significant correlation between pathological T3a upstaging and the number of preoperative risk factors (p = 0.0002). The preoperative tumor diameter and serum AST/ALT ratio can be predictive factors for pathological T3a upstaging in patients with clinical T1 RCC.

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Section: Discussionmentioning

confidence: 99%

The Preoperative Predictive Factors for Pathological T3a Upstaging of Clinical T1 Renal Cell Carcinoma

et al. 2019

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“…On the one hand, decision making in these patients is complex and nuanced; as such, beyond tumour-related characteristics, treatment decisions should also rely on careful assessment of patient-, kidney-and provider-related factors [9]. On the other hand, partial and radical nephrectomy appear to achieve similar cancer control even if the final histology shows unexpected pT3a RCC upstaging [10]. In addition, in a recent systematic review, age, tumour size and RENAL score were the three predictors of upstaging [11].…”

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confidence: 99%

Machine learning in renal cell carcinoma research: the promise and pitfalls of ‘renal‐izing’ the potential of artificial intelligence

2023

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Artificial intelligence and machine learning (ML) are increasingly applied to the study of patients with RCC [1]. Advanced techniques, such as neural networks or random forests, can be used to analyse a vast amount of clinical data to uncover specific prognostic features that may not be detectable with traditional statistical methods. However, despite some promising results, recent studies show that the benefits of ML are not ubiquitous, especially when deployed on imperfect and non-granular datasets [2].In this issue of the BJUI, Boulenger de Hauteclocque employ data from the French multi-institutional kidney cancer database UroCCR (ClinicalTrials.gov Identifier: NCT03293563), to investigate the ability of seven ML algorithms to predict pT3a upstaging in a cohort of patients who underwent surgery for cT1/cT2a RCC. Using supervised ML algorithms, they reported a prediction accuracy (measured by the area under the receiver-operating curve) of 0.77 for their best model [3]. While the results are intriguing, the design of the study raises questions that should be considered by clinicians when interpreting the results.

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“…They found that in patients with unexpected pT3a RCC at final pathology, PN does not appear to negatively affect cancer control with regard to metastatic progression and cancer-specific mortality. 25 …”

Section: Discussionmentioning

confidence: 99%

Prognostic significance of subclassifying stage pT3a renal tumors with fat invasion: a retrospective study of 99 patients

Zhu

2021

J Int Med Res

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Purpose To analyze the recurrence in patients with clinic stage T1 renal cell carcinoma (RCC) who were upstaged to stage T3a after partial nephrectomy (PN) using a new sub-classification criterion. Methods A retrospective study of pathological characteristics was performed in patients who were upstaged to pT3a on the basis of fat invasion (FI). Results After analyzing the pathological findings, we proposed the following new sub-classification criteria for pT3a RCC with FI: (1) renal tumor invades the pseudo-capsule and contacts the perinephric adipose tissue directly or the tumor protrudes into the perinephric adipose tissue like a tongue (Type A); and (2) tumor nodules are distributed in perinephric adipose tissues (Type B). A significant difference was observed in the recurrence rate between the two subtypes A and B. For Type B, the recurrence rate after radical nephrectomy (RN) and PN was 15.79% and 63.64%, respectively. The recurrence rates for Types A and B after PN were 11.11% and 63.64%, respectively. Conclusions T3a RCC with tumor nodules in perinephric adipose and/or an irregular tumor protruding into the adipose tissues lead to a higher recurrence rate. We recommend that T3a RCC be carefully analyzed and patients be treated on an individual basis.

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Does the Unexpected Presence of Non-organ-confined Disease at Final Pathology Undermine Cancer Control in Patients with Clinical T1N0M0 Renal Cell Carcinoma Who Underwent Partial Nephrectomy?

Abstract: Cancer control is similar between patients treated with removal of the entire kidney and those with only partial removal, even if the final histology examination demonstrates a tumour that is unexpectedly not confined within the kidney.

Cited by 13 publications

References 21 publications

The Preoperative Predictive Factors for Pathological T3a Upstaging of Clinical T1 Renal Cell Carcinoma

The Preoperative Predictive Factors for Pathological T3a Upstaging of Clinical T1 Renal Cell Carcinoma

Machine learning in renal cell carcinoma research: the promise and pitfalls of ‘renal‐izing’ the potential of artificial intelligence

Prognostic significance of subclassifying stage pT3a renal tumors with fat invasion: a retrospective study of 99 patients

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