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Outcomes of pathologic stage T3a renal cell carcinoma up-staged from small renal tumor: emphasis on partial nephrectomy

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Authors
Lee, Hakmin; Lee, Minseung; Lee, Sang Eun; Byun, Seok-Soo; Kim, Hyeon Hoe; Kwak, Cheol; Hong, Sung Kyu
Issue Date
2018-04-16
Publisher
BioMed Central
Citation
BMC Cancer, 18(1):427
Keywords
UpstagingRenal cell carcinomaNephrectomySurvivalStage
Abstract
Abstract

Background
The prognosis of patients with pathologic stage T3a renal cell carcinoma (RCC) that is up-staged from a small renal tumor remains controversial. We evaluated the prognosis of patients with RCC who were up-staged from clinical stage T1 to pathologic stage T3a.

Methods
We retrospectively reviewed the data of 3431 patients who were surgically treated for clinical stage T1 RCC. The survival outcomes were compared using Kaplan-Meier and Cox proportional analyses.

Results
Among the clinical stage T1 patients, 215 (6.3%) were finally up-staged to pathologic stage T3a. Patient age (HR 1.302, 95% CI 1.018–1.046, p <  0.001), tumor diameter (HR 1.686, 95% CI 1.551–1.834, p <  0.001), and hilar location (HR 1.765, 95% CI 1.147–2.715, p = 0.010) were significantly associated with upstaging. Kaplan-Meier analyses showed significantly shorter recurrence-free, cancer-specific and overall survivals (all p <  0.001) in patients who were up-staged. Multivariate Cox analyses revealed pathologic upstaging as an independent predictor of shorter recurrence-free (HR 2.195, 95% CI 1.459–3.300, p <  0.001), cancer-specific (HR 2.238, 95% CI 1.252–4.003, p = 0.007), and overall survivals (HR 1.632, 95% CI 1.029–2.588, p = 0.037). Subgroup analysis of pathologic stage T3a showed no significant difference in survival of the partial nephrectomy group when compared to the radical nephrectomy group (all p > 0.5).

Conclusions
Patients up-staged from clinical stage T1 to pathologic stage T3a RCC showed shorter survival outcomes than those without upstaging. However, partial nephrectomy, compared with radical nephrectomy, showed comparable outcomes in patients who were up-staged.
ISSN
1471-2407
Language
English
URI
http://hdl.handle.net/10371/141241
DOI
https://doi.org/10.1186/s12885-018-4338-1
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College of Medicine/School of Medicine (의과대학/대학원)Urology (비뇨기과학전공)Journal Papers (저널논문_비뇨기과학전공)
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