Evaluation of the Prognostic Significance of Perirenal Fat Invasion and Tumor Size in Patients with pT1-pT3a Localized Renal Cell Carcinoma in a Comprehensive Multicenter Study of the CORONA project. Can We Improve Prognostic Discrimination for Patients with Stage pT3a tumors?

被引：46

作者：

Brookman-May, Sabine D. ^{[1
,2
]}

May, Matthias ^{[3
]}

Wolff, Ingmar ^{[4
]}

Zigeuner, Richard ^{[5
]}

Hutterer, Georg C. ^{[5
]}

Cindolo, Luca ^{[6
]}

Schips, Luigi ^{[6
]}

De Cobelli, Ottavio ^{[7
]}

Rocco, Bernardo ^{[8
]}

De Nunzio, Cosimo ^{[9
]}

Tubaro, Andrea ^{[9
]}

Coman, Ioman ^{[10
]}

Truss, Michael ^{[11
]}

Dalpiaz, Orietta ^{[4
,11
]}

Feciche, Bogdan ^{[12
]}

Figenshau, Robert S. ^{[13
]}

Madison, Kerry ^{[13
]}

Sanchez-Chapado, Manuel ^{[14
]}

Santiago Martin, Maria del Carmen ^{[14
]}

Salzano, Luigi ^{[15
]}

Lotrecchiano, Giuseppe ^{[15
]}

Zastrow, Stefan ^{[16
]}

Wirth, Manfred ^{[16
]}

Sountoulides, Petros ^{[13
]}

Shariat, Shahrokh ^{[17
]}

Waidelich, Raphaela ^{[1
,2
]}

Stief, Christian ^{[1
,2
]}

Gunia, Sven ^{[18
]}

机构：

[1] Univ Munich, Dept Urol, Munich, Germany

[2] Janssen Pharma Res & Dev, Beerse, Belgium

[3] St Elisabeth Hosp Straubing, Dept Urol, Straubing, Germany

[4] Carl Thiem Klinikum, Dept Urol, Cottbus, Germany

[5] Med Univ Graz, Dept Urol, Graz, Austria

[6] Pio Da Pietrelcina Hosp, Dept Urol, Vasto, Italy

[7] European Inst Oncol, Div Urol, Milan, Italy

[8] Univ Milan, Osped Maggiore Policlin, Dept Urol, Milan, Italy

[9] Univ Roma La Sapienza, Fac Hlth Sci, Dept Urol, Rome, Italy

[10] Clin Municipal Hosp, Dept Urol, Cluj Napoca, Romania

[11] Klinikum Dortmund, Dept Urol, Dortmund, Germany

[12] Emergency Hosp Satu Mare, Dept Urol, Satu Mare, Romania

[13] Washington Univ, Sch Med, Div Urol Surg, St Louis, MO 63110 USA

[14] Hosp Univ Principe Asturias, Dept Urol, Madrid, Spain

[15] G Rummo Hosp, Dept Urol, Benevento, Italy

[16] Carl Gustav Carus Univ, Dept Urol, Dresden, Germany

[17] Med Univ Vienna, Vienna Gen Hosp, Dept Urol, Vienna, Austria

[18] Johanniter Hosp Stendal, Dept Pathol, Stendal, Germany

来源：

EUROPEAN UROLOGY | 2015年 / 67卷 / 05期

关键词：

Renal cell carcinoma; Perirenal fat invasion; Renal vein invasion; Tumor size; Cancer-specific survival; SINUS FAT; TNM CLASSIFICATION; INFILTRATION; T3A; SURVIVAL; SYSTEM; IMPACT; RECURRENCE; PROPOSAL; CANCER;

D O I：

10.1016/j.eururo.2014.11.055

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

100201 [内科学]; 100221 [泌尿外科学];

摘要：

Background: The current TNM system for renal cell carcinoma (RCC) merges perirenal fat invasion (PFI) and renal vein invasion (RVI) as stage pT3a despite limited evidence concerning their prognostic equivalence. In addition, the prognostic value of PFI compared to pT1-pT2 tumors remains controversial. Objective: To analyze the prognostic significance of PFI, RVI, and tumor size in pT1-pT3a RCC. Design, setting, and participants: Data for 7384 pT1a-pT3a RCC patients were pooled from 12 centers. Patients were grouped according to stages and PFI/RVI presence as follows: pT1-2N0M0 (n = 6137; 83.1%), pT3aN0M0 + PFI (n = 1036; 14%), and pT3aN0M0 (RVI +/- PFI; n = 211; 2.9%). Intervention: Radical nephrectomy or nephron-sparing surgery (NSS) (1992-2010). Outcome measurements and statistical analysis: Cancer-specific survival was estimated using the Kaplan-Meier method. Univariate and multivariate Cox proportional-hazards regression models, as well as sensitivity and discrimination analyses, were used to evaluate the impact of clinicopathologic parameters on cancer-specific mortality (CSM). Results and limitations: Compared to stage pT1-2, patients with stage pT3a RCC were significantly more often male (59.4% vs 53.1%) and older (64.9 vs 62.1 yr), more often had clear cell RCC (85.2% vs 77.7%), Fuhrman grade 3-4 (29.4% vs 13.4%), and tumor size> 7 cm (39.1% vs 13%), and underwent NSS less often (7.5% vs 36.6%; all p < 0.001). According to multivariate analysis, CSM was significantly higher for the PFI and RVI +/- PFI groups comparedtopT1-2patients (hazardratio [HR] 1.94 and 2.12, respectively; p < 0.001), whereas patients with PFI only and RVI + PFI did not differ (HR 1.17; p = 0.316). Tumor size instead enhanced CSM by 7% per cm in stage pT3a (HR 1.07; p < 0.001)with a 7 cm cutoff yielding the highest prediction accuracy. Conclusions: Since the prognostic impact of PFI and RVI on CSM seems to be comparable, merging both as stage pT3a RCC might be justified. Enhanced prognostic discrimination of stage pT3a RCC appears to be possible by applying a tumor size cutoff of 7 cm within an alternative staging system. Patient summary: Prognosis prediction for patients with localized renal cell carcinoma up to stage pT3a can be enhanced by including tumor size with a cutoff of 7 cm as an additional parameter in the TNM classification system. # 2014 European Association of Urology. Published by Elsevier B. V. All rights reserved.

引用

页码：943 / 951

页数：9

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