Risk Factors for Upstaging, Recurrence, and Mortality in Clinical T1-2 Renal Cell Carcinoma Patients Upstaged to pT3a Disease: An International Analysis Utilizing the 8th Edition of the Tumor-Node-Metastasis Staging Criteria

Hamilton, Zachary; Capitanio, Umberto; Pruthi, Deepak; Ghali, Fady; Larcher, Alessandro; Patel, Devin; Eldefrawy, Ahmed; Patel, Sunil; Cotta, Brittney; Bradshaw, Aaron; Meagher, Margaret; Miller, Nathan; Carenzi, Cristina; Wan, Fang; Liss, Michael A.; McGregor, Thomas; Montorsi, Francesco; Derweesh, Ithaar

doi:10.1016/j.urology.2019.11.036

Cited by 24 publications

(22 citation statements)

References 29 publications

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“…The positive margin of PN signi cantly increased in cT1/pT3a RCC, compared with cT1/pT1 [25]. While, positive margin was not associated with local recurrence of pT3a RCC [10]. As distant recurrence is the major risk of locally advanced T3a RCC patients, therefore, local positive margin may not be a key prognostic factor in this cohort patients.…”

Section: Discussionmentioning

confidence: 67%

“…Tumor size over 7 cm is an important poor factor for predicting the outcome of patients with pT3a RCC with fat invasion [8,9]. Furthermore, there is a trend of worse outcomes with tumor size increases from 0-4cm to 4-7cm and over 7 cm in pT3a RCC [10]. We previously showed that the PFI and SFI has similar prognosis, and single fat invasion site invasion has better survival than multiple sites invasion in pT3aN0M0 RCC [11].…”

Section: Discussionmentioning

confidence: 97%

“…It is clear that the OS/CSS of PN is comparable to RN in cT1 RCC from the prospective and retrospective clinical studies, and PN decreases chronic kidney disease [21][22][23]. The survival bene t of PN in 0-4cm pT3aN0M0 RCC may be explained by Hamilton, Z.A., which showed that most recurrences were distant with a recurrence rate of 92.5% (99/107), and loco-regional recurrence was only 11.2% (12/107) in upstaged pT3a RCC, which was even lower than loco-regional recurrence of 17.8% (30/169) in non-upstaged cT1-2 RCC [10]. Furthermore, Patel et al reported that in pathologically upstaged pT3a RCC, PN did not adversely affect risk of recurrence and provided functional bene t [24].Although, Shah et al reported that cT1/pT3a upstaged patients (49 PN/91 RN), the positive margin rate was approximately 15% (7/49) in PN, and more than half (4/7) of positive margin patients recurred [18].…”

Section: Discussionmentioning

confidence: 99%

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The Effectiveness of Partial Versus Radical Nephrectomy for pT3aN0M0 Renal Cell Carcinoma: A Propensity Score Analysis

Yang

Liu

et al. 2020

Preprint

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Background The survival benefit of partial nephrectomy (PN) in pT3a RCC patients is controversial. Here we aimed to determine the benefit of PN for T3aN0M0 renal cell carcinoma (RCC). Methods Data of patients with pT3aN0M0 RCC who were diagnosed between 2010–2012 in the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database were retrospectively collected. We compared overall survival (OS) and cancer specific survival (CSS) using a Cox proportional hazards model between PN and radical nephrectomy (RN) in pT3aN0M0 RCC. Propensity score (–adjusted, –stratified, –weighted, and –matched) analyses were performed to control for imbalances in individual risk factors. Results A total of 1277 patients with pT3aN0M0 RCC were identified, of whom 200 patients were treated with PN and 1077 patients were RN. Patients who received PN were more likely to have small tumor size, well/moderately differentiation, peritumoral fat invasion, and less likely to have multiple site invasion and clear cell adenocarcinoma type (p < 0.05). PN showed favorable OS and CSS in 0-4cm pT3aN0M0 RCC (p < 0.05), and similar OS and CSS in 4-7cm pT3aN0M0 RCC, compared with RN using un-adjusted analyses. The Propensity score analyses further demonstrated the survival benefit of PN compared with the RN in 0-4cm pT3aN0M0 RCC (p < 0.05). Conclusions In this observational study, PN was associated with improved survival compared with RN in 0-4cm pT3aN0M0 RCC. Moreover, survival was comparable between PN and RN in 4-7cm pT3aN0M0 RCC. These data provided evidence that PN is an alternative choice for T3aN0M0 RCC less than 7 cm. Patients with 0-4cm pT3aN0M0 RCC may benefit from PN.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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The Effectiveness of Partial Versus Radical Nephrectomy for pT3aN0M0 Renal Cell Carcinoma: A Propensity Score Analysis

Yang

Liu

et al. 2020

Preprint

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“…( 11 , 27 ) and Hamilton et al. ( 28 ) in their respective study series. Performing PN on tumors was more frequent in the non-pT3a upstaging group, and this may be attributed to the fact that complex lesions were mainly managed by RN.…”

Section: Discussionmentioning

confidence: 90%

Added Value of Systemic Inflammation Markers in Predicting Clinical Stage T1 Renal Cell Carcinoma Pathologically Upstaged to T3a

et al. 2021

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ObjectivesWe aimed to determine preoperative risk factors associated with pathologic T3a (pT3a) upstaging of clinical T1 (cT1) renal cell carcinomas (RCCs) and develop a novel model capable of accurately identifying those patients at high risk of harboring occult pT3a characteristics.MethodsA retrospective analysis of 1324 cT1 RCC patients who underwent partial nephrectomy (PN) or radical nephrectomy (RN) was performed. The study cohort was divided into training and testing datasets in a 70:30 ratio for further analysis. Univariable and multivariable logistic regression analyses were performed to identify predictors associated with cT1 to pT3a upstaging and subsequently, those significant risk factors were used to construct models. We used the area under the curve (AUC) to determine the model with the highest discrimination power. Decision curve analyses (DCAs) were applied to evaluate clinical net benefit associated with using the predictive models.ResultsThe rates of upstaging were 6.1% (n = 81), 5.8% (n = 54) and 6.8% (n = 27) in the total population, training cohort and validation cohort, respectively. Tumor size, clinical T stage, R.E.N.A.L. (radius, exophytic/endophytic properties, nearness of tumor to collecting system or sinus, anterior/posterior) nephrometry score, lymphocyte to monocyte ratio (LMR), prognostic nutrition index (PNI) and albumin to globulin ratio (AGR) were significantly associated with pT3a upstaging. The model that consisted of R.E.N.A.L. score, LMR, AGR and PNI achieved the highest AUC of 0.70 in the validation cohort and yielded the highest net benefit. In the subpopulation with complete serum lipid profile, the inclusion of low-density lipoprotein cholesterol (LDL-C) and Castelli risk index-I (CRI-I) significantly improved the discrimination of model (AUC = 0.86).ConclusionsOur finding highlights the importance of systemic inflammation response markers and serum lipid parameters in predicting pT3a upstaging. Our model had relatively good discrimination in predicting occult pT3a disease among patients with cT1 renal lesions, and the use of the model may be greatly beneficial to urologists in risk stratification and management decisions.

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“…A total of 3,391 patients were included, including 1,278 patients in the PN group, 2,113 patients in the RN group. Among the nine studies, two of them compared the tumor-specific survival rates between RN and PN group (19,22), five studies compared OS rates (18)(19)(20)(21)(22), two studies compared CSM (17,20), three studies compared RFS (18,23,24), three studies compared complications (20,22,25) and five studies compared positive surgical margin (18,20,(22)(23)(24). The baseline characteristics of included studies were shown in Table 2.…”

Section: Features Of Included Literaturementioning

confidence: 99%

A meta-analysis for comparison of partial nephrectomy vs. radical nephrectomy in patients with pT3a renal cell carcinoma

Liu¹,

Kong²,

Li³

et al. 2021

Transl Androl Urol

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Background: Kidney cancer is the most common malignant tumor of the kidney in adults. However, in terms of the treatment for pT3a renal cell carcinoma (RCC), whether partial nephrectomy (PN) can be selected is still controversial. This study was conducted to compare the efficacy of PN and radical nephrectomy (RN) in treatment for patients with pT3a RCC. Methods:The relative English databases including PubMed and EMBASE were searched for studies comparing PN and RN for pT3a RCC between 2010 and 2020. Stata 13.0 software was used to compare the cancer-specific survival (CSS), overall survival (OS), cancer-specific mortality (CSM), relapse-free survival (RFS), complications and positive surgical margin.Results: Nine articles were included with a total of 3,391 patients, of whom 2,113 received RN and 1,278 received PN. The results showed that there is no statistical difference in CSS, OS, CSM, RFS, complications and positive surgical margin between RN and PN. No heterogeneity was shown in study.Conclusions: There were no differences in the CSS, OS, CSM, RFS, complications and positive surgical margin of the patients in RN and PN group. For pT3a RCC, RN did not provide a better survival benefit compared to PN. Considering PN can suppress the progression of tumor and reduce the risk of postoperative chronic renal insufficiency, we found PN is a good choice for pT3a RCC. However, further large-sample, studies are still needed in future.

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Risk Factors for Upstaging, Recurrence, and Mortality in Clinical T1-2 Renal Cell Carcinoma Patients Upstaged to pT3a Disease: An International Analysis Utilizing the 8th Edition of the Tumor-Node-Metastasis Staging Criteria

Cited by 24 publications

References 29 publications

The Effectiveness of Partial Versus Radical Nephrectomy for pT3aN0M0 Renal Cell Carcinoma: A Propensity Score Analysis

The Effectiveness of Partial Versus Radical Nephrectomy for pT3aN0M0 Renal Cell Carcinoma: A Propensity Score Analysis

Added Value of Systemic Inflammation Markers in Predicting Clinical Stage T1 Renal Cell Carcinoma Pathologically Upstaged to T3a

A meta-analysis for comparison of partial nephrectomy vs. radical nephrectomy in patients with pT3a renal cell carcinoma

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