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

Abstract

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.

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

“…In contrast to our observations, Fukui et al. ( 29 ) reported that level of CRP in the upstaged group was higher than that of the non-upstaged group.…”

“…There was no difference between the nonand upstaged groups with regard to other clinical parameters including age, gender, BMI, comorbidities, lymphocyte counts, monocyte counts, albumin, globulin, CRP, ACR, PNI, TC and TG. In contrast to our observations, Fukui et al (29) reported that level of CRP in the upstaged group was higher than that of the nonupstaged group.…”

“…Jeong et al (32) also reported that the risk of pT3a upstaging was found to be associated with age. This finding was not consistent with our study or other previous publications (6,11,29), indicating that age was not a robust and consistent predictor of tumor upstaging. Noteworthy in the study by Gorin et al (6) was that hilar location became significant as an independent predictor of tumor upstaging.…”

“…Similarly, tumor size and R.E.N.A.L. score was linked to pT3a upstaging by several studies (5,6,11,27,29). Interestingly, Correa et al (30) observed that higher R.E.N.A.L.…”

Assessing the role of race in pathological upstaging of renal cell carcinoma: Results from the National Cancer Database

“…Computed tomography (CT) is the primary staging modality for RCC and is highly effective in distinguishing between cT1 (≤7cm) and cT2 renal tumours (>7cm) 1 . However, the utility of CT imaging in accurately detecting tumour invasion into the renal vein, its segmental branches, or perirenal and/or renal sinus fat—defined as cT3a disease—is limited, 3‐6 lending to reported rates of upstaging specifically to pathologic T3a (pT3a) disease in approximately 10% of all patients initially staged with cT1 RCC 7‐9 …”