Urology Department, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.
Int J Urol. 2024 Mar;31(3):252-257. doi: 10.1111/iju.15344. Epub 2023 Dec 20.
Clinical T1 (cT1) renal mass treated surgically has a good prognosis, but there is an upstaging risk that potentially threatens oncological outcomes after partial nephrectomy (PN). We aim to analyze and study the incidence, predictors, perioperative morbidity, and oncological outcomes of pT3a upstaging.
A retrospective study of 313 patients who underwent PN for cT1 renal mass at a single center from a single tertiary referral center between 2000 and 2021 was done. Demographic, perioperative, pathological, and outcome variables were reviewed. We compared these parameters between upstaged and non-upstaged groups. Multivariate logistic regression analysis was used to study preoperative variables associated with upstaging.
Nineteen patients were upstaged to pT3a. Making an incidence of 6.1%. Upstaged tumors were bigger (5.02 cm vs. 4.08 cm, p = 0.004), had higher clinical stage T1b (84.2 vs. 40.5%, p < 0.001), had more tumors which were central location (21 vs. 3.4%, p < 0.001), had more endophytic and mesophytic tumors (15.8 vs. 5.8% and 52.6 vs. 9.5%, p < 0.001), and had higher R.E.N.A.L Nephrometry score (8.05 vs. 6, p < 0.001). Upstaged tumors had more operative times (227 vs. 203 min, p = 0.01), more postoperative complications (68.4 vs. 13.1%, p < 0.001), more major complications of Clavien Dindo Grade 3 and above (15.8 vs. 4.4%, p < 0.001). Age (OR 1.035, p = 0.034), Radiological tumor dimension (OR 1.578, p = 0.003), Radiological or Clinical stage (T1b) (9.19, p = 0.008), Higher Nephrometry score (Intermediate and High) (OR 6.184, p = 0.004) were preoperative predictors of upstaging. Oncological outcomes were comparable.
Tumor upstaging was uncommon with more perioperative morbidity. Higher age, larger tumor size, higher tumor stage, and higher nephrometry scores were preoperative predictors of upstaging.
接受手术治疗的临床 T1（cT1）肾肿瘤预后良好，但部分肾切除术（PN）后存在潜在的分期升级风险，这可能威胁到肿瘤学结局。我们旨在分析和研究 pT3a 分期升级的发生率、预测因素、围手术期发病率和肿瘤学结局。
对 2000 年至 2021 年期间在一家单中心的一家三级转诊中心接受 PN 治疗 cT1 肾肿瘤的 313 名患者进行了回顾性研究。回顾了人口统计学、围手术期、病理和结局变量。我们比较了分期升级组和非分期升级组之间的这些参数。使用多变量逻辑回归分析研究与分期升级相关的术前变量。
19 名患者被升级为 pT3a，发生率为 6.1%。升级后的肿瘤更大（5.02cm 与 4.08cm，p=0.004），临床分期 T1b 更高（84.2%与 40.5%，p<0.001），肿瘤位置更靠近中心（21%与 3.4%，p<0.001），更具有内生性和中胚层特征（15.8%与 5.8%和 52.6%与 9.5%，p<0.001），且 R.E.N.A.L 肾切除术评分更高（8.05 与 6，p<0.001）。升级后的肿瘤手术时间更长（227 分钟与 203 分钟，p=0.01），术后并发症更多（68.4%与 13.1%，p<0.001），更严重的 Clavien Dindo 分级 3 级及以上并发症（15.8%与 4.4%，p<0.001）。年龄（OR 1.035，p=0.034）、肿瘤影像学尺寸（OR 1.578，p=0.003）、影像学或临床分期（T1b）（9.19，p=0.008）、更高的肾切除术评分（中高危）（OR 6.184，p=0.004）是分期升级的术前预测因素。肿瘤学结局无差异。
肿瘤分期升级并不常见，但围手术期发病率更高。更高的年龄、更大的肿瘤大小、更高的肿瘤分期和更高的肾切除术评分是分期升级的术前预测因素。
