TY - JOUR
T1 - Outcomes and predictors of clinical T1 to pathological T3a tumor up-staging after robotic partial nephrectomy
T2 - A multi-institutional analysis
AU - Gorin, Michael A.
AU - Ball, Mark W.
AU - Pierorazio, Phillip M.
AU - Tanagho, Youssef S.
AU - Bhayani, Sam B.
AU - Kaouk, Jihad H.
AU - Rogers, Craig G.
AU - Stifelman, Michael D.
AU - Khalifeh, Ali
AU - Kumar, Ramesh
AU - Sivarajan, Ganesh
AU - Allaf, Mohamad E.
PY - 2013/11
Y1 - 2013/11
N2 - Purpose: We evaluated the early oncological end point of recurrence-free survival in patients with renal cell carcinoma up-staged from cT1 to pT3a after partial nephrectomy. We also aimed to establish preoperative factors associated with pathological tumor up-staging. Materials and Methods: A prospective database of robotic partial nephrectomy cases performed at 5 academic centers was queried for patients who underwent surgery for a solitary cT1 renal mass. Patients with pT1-2 renal cell carcinoma were compared to those with pT3a tumors to determine the difference in recurrence-free survival. Preoperative factors associated with cT1 to pT3a up-staging were studied using multivariate logistic regression analysis. Results: A total of 1,096 patients underwent robotic partial nephrectomy for a cT1 renal mass. At final pathological evaluation 855 tumors (78.0%) were found to be renal cell carcinoma, of which 41 (4.8%) were up-staged to pT3a. The 24-month recurrence-free survival estimates for pT1-2 and pT3a tumors were 99.2% and 91.8%, respectively (p = 0.003). Multivariate analysis revealed that a high vs low R.E.N.A.L. (radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior and location relative to polar lines) nephrometry score was associated with tumor up-staging (OR 2.97, 95% CI 1.20-7.35, p = 0.02). On separate multivariate analysis increasing tumor diameter (OR 1.66, 95% CI 1.32-2.08, p <0.001) and hilar location (OR 2.83, 95% CI 1.43-5.61, p = 0.003) were also associated with up-staging. Conclusions: At short-term followup patients with renal cell carcinoma upstaged from cT1 to pT3a have reasonable oncological outcomes after partial nephrectomy. Factors associated with tumor up-staging include high tumor complexity, increasing tumor diameter and hilar location. Further studies are needed to determine the comparative efficacy of partial vs radical nephrectomy for small pT3a tumors.
AB - Purpose: We evaluated the early oncological end point of recurrence-free survival in patients with renal cell carcinoma up-staged from cT1 to pT3a after partial nephrectomy. We also aimed to establish preoperative factors associated with pathological tumor up-staging. Materials and Methods: A prospective database of robotic partial nephrectomy cases performed at 5 academic centers was queried for patients who underwent surgery for a solitary cT1 renal mass. Patients with pT1-2 renal cell carcinoma were compared to those with pT3a tumors to determine the difference in recurrence-free survival. Preoperative factors associated with cT1 to pT3a up-staging were studied using multivariate logistic regression analysis. Results: A total of 1,096 patients underwent robotic partial nephrectomy for a cT1 renal mass. At final pathological evaluation 855 tumors (78.0%) were found to be renal cell carcinoma, of which 41 (4.8%) were up-staged to pT3a. The 24-month recurrence-free survival estimates for pT1-2 and pT3a tumors were 99.2% and 91.8%, respectively (p = 0.003). Multivariate analysis revealed that a high vs low R.E.N.A.L. (radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior and location relative to polar lines) nephrometry score was associated with tumor up-staging (OR 2.97, 95% CI 1.20-7.35, p = 0.02). On separate multivariate analysis increasing tumor diameter (OR 1.66, 95% CI 1.32-2.08, p <0.001) and hilar location (OR 2.83, 95% CI 1.43-5.61, p = 0.003) were also associated with up-staging. Conclusions: At short-term followup patients with renal cell carcinoma upstaged from cT1 to pT3a have reasonable oncological outcomes after partial nephrectomy. Factors associated with tumor up-staging include high tumor complexity, increasing tumor diameter and hilar location. Further studies are needed to determine the comparative efficacy of partial vs radical nephrectomy for small pT3a tumors.
KW - Carcinoma, renal cell
KW - Kidney
KW - Neoplasm staging
KW - Nephrectomy
KW - Robotics
UR - http://www.scopus.com/inward/record.url?scp=84888638967&partnerID=8YFLogxK
U2 - 10.1016/j.juro.2013.06.014
DO - 10.1016/j.juro.2013.06.014
M3 - Article
C2 - 23764083
AN - SCOPUS:84888638967
SN - 0022-5347
VL - 190
SP - 1907
EP - 1911
JO - Journal of Urology
JF - Journal of Urology
IS - 5
ER -