Haruki Kume1,2,3, Yukio Homma1,2, Nobuo Shinohara1,4, Wataru Obara1,5, Tsunenori Kondo1,6, Go Kimura1,7, Hiroyuki Fujimoto1,8, Norio Nonomura1,9, Fumiya Hongo1,10, Takayuki Sugiyama1,11, Masayuki Takahashi1,12, Hiro-Omi Kanayama1,12, Tomoharu Fukumori1,12, Masatoshi Eto1,13. 1. The Cancer Registration Committee of the Japanese Urological Association, Japan. 2. Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 3. Department of Urology, National Center for Global Health and Medicine, Tokyo, Japan. 4. Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan. 5. Department of Urology, Iwate Medical University, Morioka, Japan. 6. Department of Urology, Tokyo Women's Medical University, Tokyo, Japan. 7. Department of Urology, Nippon Medical School, Tokyo, Japan. 8. Urology Division, National Cancer Center Japan, Tokyo, Japan. 9. Department of Urology, Graduate School of Medicine, Osaka University, Osaka, Japan. 10. Department of Urology, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan. 11. Department of Urology, Hamamatsu University School of Medicine, Shizuoka, Japan. 12. Department of Urology, Institute of Biomedical Sciences, Tokushima University Graduate School. 13. Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Abstract
OBJECTIVES: Perinephric fat invasion (PFI) of renal cell carcinoma (RCC) is known to be associated with adverse pathological features and poor prognosis. We analyzed these associations using a sub-group of the RCC registry of The Cancer Registration Committee of the Japanese Urological Association. METHODS: The study cohort of 2998 non-metastatic cases was retrieved from RCC registry (3648 in total). We compared clinicopathological characteristics of cases with PFI (n = 256) and without PFI (n = 2742), and investigated the impact of PFI on cancer-specific survival using univariate and multivariate analyses. RESULTS: Compared with non-PFI cases, PFI cases were older (P = 0.003), and more likely to be hypertensive (P = 0.034) and symptomatic at presentation (P < 0.001). PFI tumors were larger (P < 0.001), and more often have sarcomatoid component (P < 0.001) and tumor thrombus (P < 0.001). Cancer-specific survival was significantly shorter in cases with PFI than without (P < 0.001). The difference in survival tended to be greater in cases with large tumors but was significant in small tumor sub-groups. Cancer-specific survival was significantly shorter in cases with both PFI and renal vein involvement (RVI) in comparison to those with PFI or RVI alone (P = 0.011, P = 0.007, respectively). On multivariate analysis PFI with and without sinus fat invasion remained as an independent risk factor along with symptom at presentation, low body mass index, hypertension, multiple tumors, large tumor size (>7.0 cm), sarcomatoid component and RVI. CONCLUSIONS: PFI was associated with advanced age and aggressive pathological features. PFI is an independent prognostic factor in non-metastatic RCC.
OBJECTIVES: Perinephric fat invasion (PFI) of renal cell carcinoma (RCC) is known to be associated with adverse pathological features and poor prognosis. We analyzed these associations using a sub-group of the RCC registry of The Cancer Registration Committee of the Japanese Urological Association. METHODS: The study cohort of 2998 non-metastatic cases was retrieved from RCC registry (3648 in total). We compared clinicopathological characteristics of cases with PFI (n = 256) and without PFI (n = 2742), and investigated the impact of PFI on cancer-specific survival using univariate and multivariate analyses. RESULTS: Compared with non-PFI cases, PFI cases were older (P = 0.003), and more likely to be hypertensive (P = 0.034) and symptomatic at presentation (P < 0.001). PFI tumors were larger (P < 0.001), and more often have sarcomatoid component (P < 0.001) and tumor thrombus (P < 0.001). Cancer-specific survival was significantly shorter in cases with PFI than without (P < 0.001). The difference in survival tended to be greater in cases with large tumors but was significant in small tumor sub-groups. Cancer-specific survival was significantly shorter in cases with both PFI and renal vein involvement (RVI) in comparison to those with PFI or RVI alone (P = 0.011, P = 0.007, respectively). On multivariate analysis PFI with and without sinus fat invasion remained as an independent risk factor along with symptom at presentation, low body mass index, hypertension, multiple tumors, large tumor size (>7.0 cm), sarcomatoid component and RVI. CONCLUSIONS: PFI was associated with advanced age and aggressive pathological features. PFI is an independent prognostic factor in non-metastatic RCC.