University of Texas Health San Antonio, San Antonio, Texas.
Core Facility Statistical Consulting, Helmholtz München, Munich, Germany.
J Urol. 2023 Nov;210(5):750-762. doi: 10.1097/JU.0000000000003650. Epub 2023 Aug 14.
We sought to determine whether clinical risk factors and morphometric features on preoperative imaging can be utilized to identify those patients with cT1 tumors who are at higher risk of upstaging (pT3a).
We performed a retrospective international case-control study of consecutive patients treated surgically with radical or partial nephrectomy for nonmetastatic renal cell carcinoma (cT1 N0) conducted between January 2010 and December 2018. Multivariable logistic regression models were used to study associations of preoperative risk factors on pT3a pathological upstaging among all patients, as well as subsets with those with preoperative tumors ≤4 cm, renal nephrometry scores, tumors ≤4 cm with nephrometry scores, and clear cell histology. We also examined association with pT3a subsets (renal vein, sinus fat, perinephric fat).
Among the 4,092 partial nephrectomy and 2,056 radical nephrectomy patients, pathological upstaging occurred in 4.9% and 23.3%, respectively. Among each group independent factors associated with pT3a upstaging were increasing preoperative tumor size, increasing age, and the presence of diabetes. Specifically, among partial nephrectomy subjects diabetes (OR=1.65; 95% CI 1.17, 2.29), male sex (OR=1.62; 95% CI 1.14, 2.33), and increasing BMI (OR=1.03; 95% CI 1.00, 1.05 per 1 unit BMI) were statistically associated with upstaging. Subset analyses identified hilar tumors as more likely to be upstaged (partial nephrectomy OR=1.91; 95% CI 1.12, 3.16; radical nephrectomy OR=2.16; 95% CI 1.44, 3.25).
Diabetes and higher BMI were associated with pathological upstaging, as were preoperative tumor size, increased age, and male sex. Similarly, hilar tumors were frequently upstaged.
我们旨在确定术前影像学的临床危险因素和形态学特征是否可用于识别那些 cT1 肿瘤患者存在更高的升级风险（pT3a）。
我们进行了一项回顾性的国际病例对照研究，纳入了 2010 年 1 月至 2018 年 12 月期间接受根治性或部分肾切除术治疗非转移性肾细胞癌（cT1N0）的连续患者。多变量逻辑回归模型用于研究所有患者术前危险因素与 pT3a 病理升级之间的关系，以及术前肿瘤≤4cm、肾分肾功能评分、肿瘤≤4cm 伴分肾功能评分和透明细胞组织学的亚组关系。我们还检查了与 pT3a 亚组（肾静脉、窦脂肪、肾周脂肪）的关联。
在 4092 例部分肾切除术和 2056 例根治性肾切除术患者中，分别有 4.9%和 23.3%发生病理升级。在每组中，与 pT3a 升级相关的独立因素包括术前肿瘤大小增加、年龄增加和糖尿病。具体而言，在部分肾切除术患者中，糖尿病（OR=1.65；95%CI 1.17，2.29）、男性（OR=1.62；95%CI 1.14，2.33）和 BMI 增加（OR=1.03；95%CI 1.00，1.05 每增加 1 个 BMI 单位）与升级具有统计学相关性。亚组分析发现，肾门肿瘤更有可能升级（部分肾切除术 OR=1.91；95%CI 1.12，3.16；根治性肾切除术 OR=2.16；95%CI 1.44，3.25）。
糖尿病和较高的 BMI 与病理升级相关，术前肿瘤大小、年龄增加和男性也是如此。同样，肾门肿瘤常被升级。
