Prognosis, Predictors, and Treatment for pT3a Upstaging in cT1 Renal Cell Carcinoma

Ana Marinho1,2*, Belmiro Parada1,2, Edson Retroz1,2, Pedro Nunes1,2, Pedro Simões1 and Arnaldo Figueiredo1,2

1Department of Urology and Renal Transplantation, Hospital and University Center of Coimbra, Portugal 2Department of Medicine of Coimbra, University of Coimbra, Portugal

^*Correspondance to: Ana Marinho 

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Abstract:

Purpose: The significance of upstaging of cT1 to pT3a (cT1pT3a) Renal Cell Carcinomas (RCC) is not clear. The objectives of this study were to assess the impact of this upstaging on Overall Survival (OS), Cancer Specific Survival (CSS), Recurrence-Free (RFS) and Metastases-Free Survival (MFS); to identify predictive factors for cT1pT3a and to evaluate the safety of partial nephrectomy in cT1p3a tumors. Material and Methods: A retrospective analysis was performed of 429 cases of cT1N0M0 RCC submitted to nephrectomy, partial or radical, between January 2010 and December 2019. Kaplan- Meier method and Log Rank test were applied to evaluate long-term results. Logistic regression was applied to assess predictive factors. Results: There were 39 cases of upstaging. The OS, CSS, MFS were significantly lower in the cT1pT3a group compared to cT1pT1 group. RFS was lower in cT1pT3a group, but the difference was not significant. The higher the RENAL score and the larger the lesion, the greater the probability of upstaging. cT1 tumors in dialysis patients had lower risk of upstaging. OS, CSS, MFS were significantly higher in cT1pT3a patients submitted to partial nephrectomy regarding those undergoing radical nephrectomy. The RFS was higher, but the difference was not significant. Conclusion: cT1pT3a RCC had a worse prognosis. It was found that the larger and more complex the nodule, the greater the probability of cT1pT3a. In patients on dialysis the lesions had a lower risk of upstaging. Even in cases with a high probability of upstaging, partial nephrectomy can be offered if technically feasible.

Keywords:

Renal cell carcinoma; Clinical T1; Pathological T3a; Oncological outcomes; Predictive factors

Cite the Article:

Marinho A, Parada B, Retroz E, Nunes P, Simões P, Figueiredo A. Prognosis, Predictors, and Treatment for pT3a Upstaging in cT1 Renal Cell Carcinoma. Ann Clin Case Rep. 2022; 7: 2143..