Puri Dhruv, Lane Brian R, Birouty Natalie, Wang Luke, Meagher Margaret F, Cortes Julian, Guer Melis, Nguyen Mimi, Ahdoot Aaron, Dabbas Mai, Afari Jonathan, Yuen Kit, Saitta Cesare, Kim Simon, Derweesh Ithaar H
Department of Urology, UC San Diego School of Medicine, La Jolla, USA.
Department of Urology, Corewell Health, Grand Rapids, USA.
Urol Oncol. 2025 Sep;43(9):523.e19-523.e27. doi: 10.1016/j.urolonc.2024.09.010. Epub 2025 May 8.
To compare outcomes of pathological T3a renal cell carcinoma (RCC) based on clinical stage at presentation, and to propose reclassification of T3a RCC based on survival outcomes, as outcomes of current T3a RCC may vary based on initial clinical presentation.
Using the National Cancer Database, patients with pT2 and pT3aN0M0 RCC were categorized by AJCC clinical T stage. Primary outcome was overall survival (OS). Multivariable analysis (MVA) assessed predictors for all-cause mortality (ACM), controlling for presenting clinical T stage. Kaplan-Meier Analysis (KMA) assessed differences between cT1-upstaged pT3a (cT1→pT3a), cT2-upstaged pT3a (cT2→pT3a), clinical/pathological T2 (cT2→pT2), and clinical/pathological T3a (cT3a→pT3a) RCC, and a modified T3a RCC was created based on clustering of survival outcomes between clinical staging groups. ROC/AUC analysis was utilized to compare predictive value of AJCC 8 edition staging vs. proposed staging.
45,097 patients with pT3a disease were analyzed (9,730 cT1→pT3a; 7,209 cT2→pT3a, 19,857 cT2→pT2; and 8,301 cT3a→pT3a). MVA for OS [cT1→pT3a (referent)] demonstrated cT2→pT3a (HR=1.27, p<0.001) and cT3a→pT3a (HR=1.20, p<0.001) were associated with worsened ACM, while cT2→pT2 (HR=0.95, p=0.052) was not significantly different. KMA for 5-year OS using current AJCC demonstrated: cT1→pT3a 73.1%, cT2→pT2 78.0%, cT2→pT3a 60.8%, cT3a→pT3a 59.9% (p<0.001). KMA for 5-year OS of a new pT2 group, comprised of cT1→pT3a and cT2→pT2, while maintaining cT2→pT3a and cT3a→pT3a as T3a was 78.0% vs. 60.3% (p=0.003). ROC analysis for OS revealed AUC of 0.532 (95% CI: 0.530-0.535) for T3 using current AJCC 8 edition TNM staging and AUC of 0.573 (95% CI: 0.569-0.577) for proposed T3a reclassification (p<0.001).
Reclassification of cT1→pT3a and cT2→ pT2 into a new T2 RCC while maintaining cT2→pT3a and cT3a→pT3a RCC in T3a RCC resulted in improved performance of the realigned model for OS. Revised TNM criteria for pT2 and T3a RCC should be considered.
比较初诊时临床分期不同的病理T3a期肾细胞癌（RCC）的预后，并基于生存结果对T3a期RCC进行重新分类，因为目前T3a期RCC的预后可能因初始临床表现而异。
利用国家癌症数据库，将pT2和pT3aN0M0期RCC患者按美国癌症联合委员会（AJCC）临床T分期进行分类。主要结局为总生存期（OS）。多变量分析（MVA）评估全因死亡率（ACM）的预测因素，并对初诊时的临床T分期进行校正。Kaplan-Meier分析（KMA）评估cT1上调至pT3a（cT1→pT3a）、cT2上调至pT3a（cT2→pT3a）、临床/病理T2期（cT2→pT2）和临床/病理T3a期（cT3a→pT3a）RCC之间的差异，并根据临床分期组之间的生存结果聚类创建改良的T3a期RCC。利用ROC/AUC分析比较AJCC第8版分期与拟议分期的预测价值。
分析了45,097例pT3a期疾病患者（9,730例cT1→pT3a；7,209例cT2→pT3a，19,857例cT2→pT2；8,301例cT3a→pT3a）。OS的MVA分析[cT1→pT3a（参照组）]显示，cT2→pT3a（HR=1.27，p<0.001）和cT3a→pT3a（HR=1.20，p<0.001）与ACM恶化相关，而cT2→pT2（HR=0.95，p=0.052）无显著差异。采用当前AJCC分期的5年OS的KMA分析显示：cT1→pT3a为73.1%，cT2→pT2为78.0%，cT2→pT3a为60.8%，cT3a→pT3a为59.9%（p<0.001）。新pT2组（由cT1→pT3a和cT2→pT2组成）5年OS的KMA分析，同时将cT2→pT3a和cT3a→pT3a维持为T3a期，结果为78.0%对60.3%（p=0.003）。OS的ROC分析显示，采用当前AJCC第8版TNM分期的T3期AUC为0.532（95%CI：0.530-0.535），拟议的T3a重新分类的AUC为0.573（95%CI：0.569-0.577）（p<0.001）。
将cT1→pT3a和cT2→pT2重新分类为新的T2期RCC，同时将cT2→pT3a和cT3a→pT3a维持为T3a期RCC，可提高重新调整后的OS模型的性能。应考虑修订pT2和T3a期RCC的TNM标准。
