Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
Department of Innovative Research and Education for Clinicians and Trainees, Fukushima Medical University Hospital, Fukushima, Japan.
Jpn J Clin Oncol. 2024 Feb 7;54(2):160-166. doi: 10.1093/jjco/hyad142.
To investigate predictive factors and oncological outcomes of pathological T3a upstaging in renal cell carcinoma patients who were initially diagnosed as clinical T1 and treated with partial nephrectomy.
The clinical records and survival data of 1617 patients, who had undergone partial nephrectomy for clinical T1 renal cell carcinoma at Tokyo Women's Medical University, Tokyo, Japan between January 2011 and December 2020, were analyzed retrospectively.
Of 1617 clinical T1 renal cell carcinoma patients who underwent partial nephrectomy, 28 (1.73%) had pathological T3a upstaging. In the multivariable analysis for pathological T3a upstaging using logistic regression models, male sex and clinical T1b were significant factors associated with pathological T3a upstaging (male sex: odds ratio = 5.07, 95% confidence interval: 1.18-21.8, clinical T1b: odds ratio = 8.36, 95% confidence interval: 3.56-19.6). The Kaplan-Meier method of the recurrence-free survival showed shorter recurrence-free survival in patients with pathological T3a upstaging than in those with pathological T1 (P < 0.0001). In the multivariable analysis using Cox proportional hazards regression models, pathological T3a upstaging was no longer significantly associated with recurrence-free survival after adjustment for other pathological factors (hazard ratio = 1.59, 95% confidence interval: 0.58-4.36). In a sensitivity analysis that analyzed its components individually instead of whole pathological T3a, neither perinephric fat invasion, sinus fat invasion, nor renal vein invasion was associated with recurrence-free survival.
Male sex and clinical T1b were significant predictors for pathological T3a upstaging after partial nephrectomy in clinical T1 renal cell carcinoma patients. Although patients with pathological T3a upstaging had worse recurrence-free survival compared with those without upstaging, multivariable analyses revealed that pathological T3a upstaging was not an independent predictor for poor recurrence-free survival.
探讨初始诊断为临床 T1 并接受部分肾切除术治疗的肾细胞癌患者中病理 T3a 升级的预测因素和肿瘤学结果。
回顾性分析了 2011 年 1 月至 2020 年 12 月期间在日本东京女子医科大学接受部分肾切除术治疗的 1617 例临床 T1 肾细胞癌患者的临床记录和生存数据。
在接受部分肾切除术的 1617 例临床 T1 肾细胞癌患者中，有 28 例（1.73%）发生病理 T3a 升级。在使用逻辑回归模型进行病理 T3a 升级的多变量分析中，男性和临床 T1b 是与病理 T3a 升级相关的显著因素（男性：优势比=5.07，95%置信区间：1.18-21.8；临床 T1b：优势比=8.36，95%置信区间：3.56-19.6）。无复发生存的 Kaplan-Meier 方法显示，病理 T3a 升级患者的无复发生存率低于病理 T1 患者（P<0.0001）。在使用 Cox 比例风险回归模型进行的多变量分析中，在调整其他病理因素后，病理 T3a 升级与无复发生存率不再显著相关（风险比=1.59，95%置信区间：0.58-4.36）。在一项单独分析而非整体病理 T3a 的敏感性分析中，肾周脂肪浸润、窦脂肪浸润和肾静脉浸润均与无复发生存无关。
在临床 T1 肾细胞癌患者中，男性和临床 T1b 是部分肾切除术后病理 T3a 升级的显著预测因素。尽管与未升级的患者相比，病理 T3a 升级的患者无复发生存率较差，但多变量分析显示，病理 T3a 升级不是无复发生存不良的独立预测因素。
