Login to Access Video or Poster Abstract: MP67-10
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Introduction

The accurate risk assessment of pathologic T3a renal cell carcinoma (RCC) remains a challenge. To develop a more precise risk stratification system, we investigated the prognostic impact of tumor growing into fatty tissue around kidney or renal vein.

Methods

We retrospectively reviewed the medical records of 211 patients with a pathologic diagnosis of T3aN0M0 RCC. Recurrence free survival was estimated using the Kaplan-Meier method. Factors associated with survival outcome were studied using multivariable Cox regression analysis.

Results

Overall 59% of patients had isolated fat invasion, 19% had isolated renal vein involvement, and 23% had both histologic features. Patients were divided in 2 groups: fat invasion or renal vein involvement (group A) and fat invasion plus renal vein involvement (group B). Group B had a significantly worse recurrence free survival than group A on Kaplan-Meier curve (p = 0.001). At multivariable Cox regression analysis, this new stratified group B was found to be an independent prognostic predictor of recurrence free survival (HR = 1.964, 95% CI = 1.059-3.632, p = 0.032) after adjusting for gender, tumor size, tumor necrosis, angoilymphatic invasion, and sarcomatoid differentiation.

Conclusions

Patients with pathologic T3a RCC with both fat invasion and renal vein involvement increased risk of recurrence after nephrectomy. According to fat invasion and renal vein involvement, the pathologic T3a RCC should be sub-divided into those with favorable and unfavorable disease.

Funding

none