Multi-institutional Survival Analysis of Incidental Pathologic T3a Upstaging in Clinical T1 Renal Cell Carcinoma Following Partial Nephrectomy

To evaluate whether incidental pathologic T3a (pT3a) upstaging after partial nephrectomy (PN) for clinical T1 disease results in inferior oncologic outcomes compared to pT1a-b disease. Retrospective chart review was completed at the University of Michigan and Moffitt Cancer Center to identify patien...

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Published in:Urology (Ridgewood, N.J.) N.J.), 2018-07, Vol.117, p.95-100
Main Authors: Russell, Christopher M., Lebastchi, Amir H., Chipollini, Juan, Niemann, Adam, Mehra, Rohit, Morgan, Todd M., Miller, David C., Palapattu, Ganesh S., Hafez, Khaled S., Sexton, Wade J., Spiess, Philippe E., Weizer, Alon Z.
Format: Article
Language:English
Subjects:
Aged
Carcinoma, Renal Cell - mortality
Carcinoma, Renal Cell - pathology
Carcinoma, Renal Cell - surgery
Disease-Free Survival
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Kidney Neoplasms - mortality
Kidney Neoplasms - pathology
Kidney Neoplasms - surgery
Male
Middle Aged
Neoplasm Recurrence, Local - mortality
Neoplasm Recurrence, Local - pathology
Neoplasm Staging
Nephrectomy - methods
Nephrectomy - mortality
Proportional Hazards Models
Retrospective Studies
Survival Rate
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Summary:To evaluate whether incidental pathologic T3a (pT3a) upstaging after partial nephrectomy (PN) for clinical T1 disease results in inferior oncologic outcomes compared to pT1a-b disease. Retrospective chart review was completed at the University of Michigan and Moffitt Cancer Center to identify patients undergoing PN for clinical T1 masses between 1995 and 2015. A total of 1955 patients were identified, of which 95 had pT3a upstaging. Median follow-up was 38.2 months. Patients with pT3a disease were individually matched by clinicopathologic features with patients undergoing PN with pT1a-b disease in a 1:2 ratio. Kaplan-Meier analysis and univariate and multivariable Cox proportional hazards regression analysis were performed. Primary endpoint was recurrence-free survival (RFS). Secondary endpoints were all-cause mortality, cancer-specific survival (CSS), and rates of local and distant recurrence. Recurrence rates were significantly higher in pT3a disease compared to pT1a-b controls (P 
ISSN:0090-4295
1527-9995
DOI:10.1016/j.urology.2018.04.002