DOES PATHOLOGICAL T3A UPSTAGING OF CLINICAL T1 STAGE HAS ANY DIFFERENCE ON LONG-TERM SURVIVAL WHEN COMPARED TO PATHOLOGICAL AND CLINICAL T1 STAGE RENAL CELL CARCINOMA
Abstract
Background: A high number of clinical T1 (cT1) stage renal cell carcinoma (RCC) is upstaged to pathological T3a (pT3a) stage on histopathological findings. Several study results show that there is no survival difference among those cT1 stage who are upstaged on histopathological findings to those who remain pT1 stage RCC.
Objectives: The objectives of this study were to assess any survival difference for cT1 stage renal cell carcinoma (RCC) which is upstaged to pT3a stage as compared to those which remain pT1 stage RCC on histopathological findings.
Materials and Methods: It was a retrospective cohort study looking at patient aged ≥18 years with cT1 RCC who underwent nephrectomy between January 2006 and December 2016. Patients were divided into two groups based on histopathological findings (pT1 vs. pT3a). Survival was analysed for the two groups using Kaplan–Meier method, and the difference in survival was calculated using log-rank model.
Results: The study included 187 patients. The mean age at presentation was 52.56 years, with 58.3% of the patients being male while 41.7% were female. The most common presentation was incidental diagnosis (50.3%). Overall
5-year survival for cT1a and pT1a RCC was 68% while that for cT1a and pT3a RCC was 100%. There was no significant survival difference among the two groups (P = 0.316). The overall 5-year survival for cT1b and pT1b RCC was 81% while that for cT1b and pT3a was 65%. There was no significant survival difference among the two groups (P = 0.136).
Conclusion: We found no survival difference in cT1 RCC who were upstaged to pT3a on histopathology as compared to cT1 RCC-staged pT1 on histopathology.
Key words: Clinical T1 stage, pathological T3a stage, radical nephrectomy, renal cell carcinoma, survival
References
Robins DJ, Small AC, Amin MB, et al. The 2017 American joint committee on cancer eighth edition cancer staging manual: Changes in staging guidelines for cancers of the kidney, renal pelvis and ureter, bladder, and urethra. J Urol 2017;197:1163.
Novara G, Ficarra V, Antonelli A, et al. Validation of the 2009 TNM version in a large multi-institutional cohort of patients treated for renal cell carcinoma: Are further improvements needed? Eur Urol 2010;58:588-95.
Kim SP, Alt AL, Weight CJ, et al. Independent validation of the 2010 American joint committee on cancer TNM classification for renal cell carcinoma: Results from a large, single institution cohort. J Urol 2011;185:2035-9.
Roberts WW, Bhayani SB, Allaf ME, et al. Pathological stage does not alter the prognosis for renal lesions determined to be stage T1 by computerized tomography. J Urol 2005;173:713-5.
Ramaswamy K, Kheterpal E, Pham H, et al. Significance of pathologic T3a upstaging in clinical T1 renal masses undergoing nephrectomy. Clin Genitourin Cancer 2015;13:344-9.
Hollingsworth JM, Miller DC, Daignault S, et al. Rising incidence of small renal masses: A need to reassess treatment effect. J Natl Cancer Inst 2006;98:1331-4.
Luciani LG, Cestari R, Tallarigo C. Incidental renal cell carcinoma-age and stage characterization and clinical implications: Study of 1092 patients (1982-1997). Urology 2000;56:58-62.
Laguna MP, Algaba F, Cadeddu J, et al. Current patterns of presentation and treatment of renal masses: A clinical research office of the endourological society prospective study. J Endourol 2014;28:861-70.
Ljungberg B, Bensalah K, Canfield S, et al. EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol 2015;67:913-24.
Gorin MA, Ball MW, Pierorazio PM, et al. Outcomes and predictors of clinical T1 to pathological T3a tumor up-staging after robotic partial nephrectomy: A multiinstitutional analysis. J Urol 2013;190:1907-11.
Srivastava A, Patel HD, Joice GA, et al. Incidence of T3a up-staging and survival after partial nephrectomy: Sizestratified rates and implications for prognosis. Urol Oncol 2018;36:12.e7-000000.
Lee H, Lee M, Lee SE, et al. Outcomes of pathologic stage T3a renal cell carcinoma up-staged from small renal tumor: Emphasis on partial nephrectomy. BMC Cancer 2018;18:427.
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