- •pT3a stage in non-metastatic renal cell carcinoma encloses various invasion patterns, but their oncological outcomes remain unclear.
- •We demonstrated that having more than 2 invasion patterns is associated with worse survival outcomes.
- •As a consequence, the concurrent presence of ≥ 2 invasion patterns might imply potential role for either adjuvant therapy or a more stringent follow-up.
A better definition of the prognostic significance of non-metastatic pT3a stage RCC subcategories is crucial to select the best candidate for adjuvant treatment. The aim of the study is to investigate the differential prognosis of extrarenal involvement in patients with non-metastatic pT3a RCC.
From a single institutional prospective database, 451 consecutive patients treated for pT3aN0/NxM0 RCC were selected and stratified according to pT3a subtypes (perirenal fat invasion, sinus fat invasion, segmental/renal vein thrombus, ≥ 2 features). Cancer specific survival (CSS), metastasis free survival (MFS) and relapse free survival (RFS) were primary endpoints of multivariable Cox regression models.
Overall, 67 (15%) patients presented with renal/segmental vein thrombus only, 185 (41%) with perirenal fat invasion, 101 (22%) with sinus fat invasion and 98 (22%) with ≥ 2 features. The presence of ≥ 2 pT3a features was associated with a higher risk of metastasis (HR=2.36; 95%CI 1.30–4.27; P value = .005), recurrence (HR=2.41; 95%CI 1.36-4.28; P value=.003) and cancer specific mortality (HR=3.54; 95%CI 1.45–8.63; P value = .005) compared to only 1 pT3a feature. Moreover, the presence of perirenal fat invasion was associated with lower CSS (HR=2.82; 95% CI 1.19–6.69; P value = .02) compared to sinus fat invasion or tumoral thrombus only.
The concurrent presence of ≥ 2 pT3a features is associated to a higher risk of distant progression, relapse and cancer specific mortality, implying potential role for adjuvant therapy or a more stringent follow-up. Moreover, perirenal fat invasion is associated with worse CSS compared to other pT3a patterns taken alone.
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Published online: February 24, 2023
Accepted: February 19, 2023
Received in revised form: February 13, 2023
Received: August 14, 2022
Publication stageIn Press Journal Pre-Proof
G.M. and G.F. contributed equally to this work as first authors.
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