PURPOSE: Tumor size and stage are important prognostic parameters in renal cell carcinoma. While pathological stage T1 and T2 are defined by size alone, the presence of certain intrinsic features can up stage a tumor to pathological stage T3a regardless of size. We investigate the effect of pathological tumor stage on the relationship between tumor size and risk of disease recurrence. MATERIALS AND METHODS: Data were reviewed on patients who underwent nephrectomy at our institution between 2006 and 2013 to identify all those with pathological stage T1, T2 and T3a tumors. A proportional hazards Cox model was built with time to recurrence as outcome, and pathological stage and tumor size as covariates. An interaction term 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 validated pathological stage T3a as a poor prognostic factor in renal cell carcinoma regardless of tumor size. Our results also demonstrated an increased rate of risk of recurrence with perinephric fat invasion. Given this increased risk of recurrence, even in tumors less than 4 cm, closer surveillance is warranted in such cases and the role of perinephric involvement necessitates further investigation.
PURPOSE:Tumor size and stage are important prognostic parameters in renal cell carcinoma. While pathological stage T1 and T2 are defined by size alone, the presence of certain intrinsic features can up stage a tumor to pathological stage T3a regardless of size. We investigate the effect of pathological tumor stage on the relationship between tumor size and risk of disease recurrence. MATERIALS AND METHODS: Data were reviewed on patients who underwent nephrectomy at our institution between 2006 and 2013 to identify all those with pathological stage T1, T2 and T3a tumors. A proportional hazards Cox model was built with time to recurrence as outcome, and pathological stage and tumor size as covariates. An interaction term 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 validated pathological stage T3a as a poor prognostic factor in renal cell carcinoma regardless of tumor size. Our results also demonstrated an increased rate of risk of recurrence with perinephric fat invasion. Given this increased risk of recurrence, even in tumors less than 4 cm, closer surveillance is warranted in such cases and the role of perinephric involvement necessitates further investigation.
Authors: Bradley C Leibovich; John C Cheville; Christine M Lohse; Horst Zincke; Eugene D Kwon; Igor Frank; R Houston Thompson; Michael L Blute Journal: J Urol Date: 2005-03 Impact factor: 7.450
Authors: R Houston Thompson; Bradley C Leibovich; John C Cheville; Christine M Lohse; Igor Frank; Eugene D Kwon; Horst Zincke; Michael L Blute Journal: J Urol Date: 2005-03 Impact factor: 7.450
Authors: R Houston Thompson; Bradley C Leibovich; John C Cheville; W Scott Webster; Christine M Lohse; Eugene D Kwon; Igor Frank; Horst Zincke; Michael L Blute Journal: J Urol Date: 2005-10 Impact factor: 7.450
Authors: Ofer N Gofrit; Amos Shapiro; Galina Pizov; Ezekiel H Landau; Ran Katz; Kevin C Zorn; Dov Pode Journal: J Urol Date: 2007-05 Impact factor: 7.450
Authors: John S Lam; Tobias Klatte; Jean-Jacques Patard; Rakhee H Goel; François Guillè; Bernard Lobel; Clement-Claude Abbou; Alexandre De La Taille; Jacques Tostain; Luca Cindolo; Vincenzo Altieri; Vincenzo Ficarra; Walter Artibani; Tommaso Prayer-Galetti; Luigi Schips; Richard Zigeuner; Allan J Pantuck; Robert A Figlin; Arie S Belldegrun Journal: Eur Urol Date: 2007-02-07 Impact factor: 20.096
Authors: Sameer A Siddiqui; Igor Frank; Bradley C Leibovich; John C Cheville; Christine M Lohse; Horst Zincke; Michael L Blute Journal: J Urol Date: 2007-01 Impact factor: 7.450
Authors: Robert Houston Thompson; Michael L Blute; Amy E Krambeck; Christine M Lohse; James S Magera; Bradley C Leibovich; Eugene D Kwon; Igor Frank; John C Cheville Journal: Am J Surg Pathol Date: 2007-07 Impact factor: 6.394