Presented by: Ray Lee
Department of Urology, Asan Medical Center

Introduction

Pathological T3a renal cell carcinoma (RCC) encompasses three different types of locally advanced features and hence the debate on prognostic heterogeneity and need for reclassification persists. We aimed to identify the prognostic significance of the site of invasion. 

Materials

Data of 1,606 patients with pT3aN0M0 RCC who underwent nephrectomy between 1988 and 2020 at three institutions were grouped according to the site of invasion: perinephric fat invasion (PFI), sinus fat invasion (SFI), renal vein invasion (RVI), PFI and SFI without RVI (PFI+SFI), and RVI with PFI and/or SFI (RVI+FI). Clinicopathological characteristics and recurrence-free (RFS) and cancer-specific survival (CSS) were compared to identify prognostic factors. Median follow-up was 59.8 months (IQR 28.1, 93.7). 

Results

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Groups with PFI+SFI, RVI and RVI+FI had significantly poorer characteristics: larger tumor size, higher nuclear grade, more frequent sarcomatoid differentiation and lymphovascular invasion. Five-year RFS were 75.8%, 66.9%, 61.7%, 60.9%, and 47.9% for SFI, PFI, PFI+SFI, RVI and RVI+FI groups, respectively (p<0.001). On multivariate analysis, site of invasion was an independent prognostic factor in addition to tumor size, histologic subtype, and nuclear grade. Compared to SFI or PFI, PFI+SFI (HR 1.531, 95%CI 1.059-2.212, p=0.024), RVI (HR 1.809, 95%CI 1.243-2.634, p=0.002), RVI+FI (HR 2.400, 95%CI 1.801-3.198, p<0.001) were associated with poorer RFS. On subgroup analysis stratified according to the tumor size (4cm, >4cm and 7cm, >7cm), survivals were consistently poorer for the vein invasion groups compared to the fat invasion groups.

Conclusion

In T3a RCC, site of invasion was an independent progsnoticator of survival regardless of tumor size. Our findings may have implications for the selection of follow-up strategies and identifying optimal candidates for adjuvant therapy.

Funding

None

Co-Authors

Kyeng Hyun Nam, MD
Department of Urology, Asan Medical Center

Jungyo Suh, MD, PhD
Department of Urology, Asan Medical Center

Cheryn Song, MD, PhD, MPH
Department of Urology, Asan Medical Center

Minyong Kang, MD, PhD
Department of Urology, Samsung Medical Center

Seong Il Seo, MD, PhD
Department of Urology, Samsung Medical Center

Chang-Wook Jeong, MD, PhD
Department of Urology, Seoul National University Hospital

Cheol Kwak, MD, PhD
Department of Urology, Seoul National University Hospital