Capsular involvement in patients undergoing partial nephrectomy for localized renal cell carcinoma: an adverse pathological finding?

Study Type – Prognosis (case series)
Level of Evidence 4 OBJECTIVE To evaluate the prognostic impact of capsular involvement (CaI) in patients treated exclusively with partial nephrectomy (PN) for localized renal cell carcinoma (RCC), as in these patients CaI was recently reported as an adverse prog...

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Bibliographic Details
Published in:BJU international 2010-03, Vol.105 (5), p.616-619
Main Authors: Rouach, Yannick, Delongchamps, Nicolas, Timsit, Marc‐Olivier, Verkarre, Virginie, Fontaine, Eric, Peyromaure, Mickael, Mejean, Arnaud
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Biological and medical sciences
capsular involvement
Carcinoma, Renal Cell - mortality
Carcinoma, Renal Cell - pathology
Carcinoma, Renal Cell - surgery
Epidemiologic Methods
Humans
Kidney - pathology
kidney cancer
Kidney Neoplasms - mortality
Kidney Neoplasms - pathology
Kidney Neoplasms - surgery
Kidneys
Medical sciences
Middle Aged
Neoplasm Recurrence, Local - pathology
Nephrectomy - methods
Nephrology. Urinary tract diseases
partial nephrectomy
Prognosis
Tumors of the urinary system
Young Adult
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Summary:Study Type – Prognosis (case series)
Level of Evidence 4 OBJECTIVE To evaluate the prognostic impact of capsular involvement (CaI) in patients treated exclusively with partial nephrectomy (PN) for localized renal cell carcinoma (RCC), as in these patients CaI was recently reported as an adverse prognostic factor. PATIENTS AND METHODS We retrospectively reviewed the medical records of patients treated with PN for a sporadic and localized RCC (pT1‐pT2N0M0) in our institution between 1985 and 2005. Univariate and multivariate analysis using a Cox proportional‐hazards regression analysis were conducted to identify significant predictors of oncological outcome for several clinical and pathological factors, i.e. imperative indication, histological type, Fuhrman grade, tumour size, T stage, CaI, and surgical margins. Disease‐free and ‐specific survival rates of patients with CaI and no evidence of CaI were compared using the log‐rank test. RESULTS In all, 305 patients had a PN for localized RCC, of whom 22 (7.2%) had CaI in the PN specimen. The median (range) follow‐up was 6 (1.5–23) years. Multivariate statistical analysis showed that imperative indication for PN and high‐grade RCC were independently associated with worse disease‐free and ‐specific survival, whereas CaI had no prognostic value. Disease‐free and ‐specific survival in patients with and without CaI were not significantly different at 5 and 10 years. CONCLUSIONS In a contemporary series of patients exclusively treated with PN for localized RCC, CaI was not predictive of disease recurrence and disease‐specific mortality. These results do not support the use of any change in postoperative management in patients with CaI after PN.
ISSN:1464-4096
1464-410X
DOI:10.1111/j.1464-410X.2009.08797.x