Prognostic Impact of pT3a Components (Perirenal Fat or Adrenal Gland Involvement) in Patients with pT3b Renal Cell Carcinoma

Dong Woo Lee; Eun Sang Yoo; Tae Gyun Kwon

doi:10.4111/kju.2009.50.2.105

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Lee, Yoo, and Kwon: Prognostic Impact of pT3a Components (Perirenal Fat or Adrenal Gland Involvement) in Patients with pT3b Renal Cell Carcinoma

Original Article

Korean J Urol 2009;50(2):105-110.

Published online: 19 February 2009

DOI: https://doi.org/10.4111/kju.2009.50.2.105

Prognostic Impact of pT3a Components (Perirenal Fat or Adrenal Gland Involvement) in Patients with pT3b Renal Cell Carcinoma

Dong Woo Lee, Eun Sang Yoo, Tae Gyun Kwon

From the Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea

Correspondence to: Tae Gyun Kwon Department of Urology, School of Medicine, Kyungpook National University, 200, Dongduk-ro, Jung-gu, Daegu 700-721, Korea TEL: 053-420-5841 FAX: 053-421-9618 E-mail: tgkwon@knu.ac.kr

Received 11 July 2008 Accepted 8 September 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To analyze the prognostic impact of the pT3a components, perirenal fat or adrenal gland involvement, in patients with pT3b renal cell carcinoma (RCC).

Materials and Methods

Between January 1997 and June 2006, a total of 36 patients with pT3b RCC who underwent radical nephrectomy with complete resection of the tumor thrombus were included. The presence of pT3a components was reviewed retrospectively, and disease-specific survival was compared between the pT3b only group and the pT3b with pT3a group by the Kaplan-Meier method. To evaluate the prognostic impact of the pure pT3a and pT3b components, we also compared these results with those of pT3aN0M0 only patients (n=44).

Results

After a thorough review by a pathologist, 21 patients were identified as having pT3b only and 15 patients as having pT3b+pT3a. The mean disease-specific survival time in those with pT3b only was significantly longer at 42±7 (SE) months compared with 18±4 (SE) months in those with pT3b+pT3a. The mean disease-specific survival time in those with pT3aN0M0 was significantly longer than in the pT3bN0M0 group and pT3b+pT3aN0M0 group. In multivariate analyses by use of the Cox-proportional hazard model, the presence of pT3a components (p=0.032), preoperative metastasis (p=0.001), and preoperative ECOG performance status (p=0.001) were recognized as predictors of a poor prognosis.

Conclusions

In patients with pT3b RCC, the presence of pT3a components might be indicative of significantly poor prognosis. Careful preoperative and postoperative evaluation should be performed, and pT3b RCC should be reclassified according to the presence of pT3a components.

Keywords: Renal cell carcinoma, Thrombosis, Fats, Adrenal glands, Prognosis

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Fig. 1.

Kaplan-Meier disease-specific survival after nephrectomy (Any N, M).

Fig. 2.

Kaplan-Meier disease-specific survival after nephrectomy (N0, M0).

Table 1.

Patients’ characteristics and pathologic results (Any N, M)

	Any N, M		p-value
	pT3b	pT3b＋pT3a	p-value
No. of patients	21	15
Age (years)	60.3±10	60.0±13	0.349^a
Sex (male:female)	14:7	10:5	1.000^b
Tumor size (cm)	8.0±2.9	9.2±2.4	0.918^a
Laterality (right:left)	12:9	8:7	0.821^b
Location (%)			0.495^b
Upper	8 (38.1)	5 (33.3)
Mid	6 (28.6)	6 (40.0)
Lower	7 (33.3)	4 (26.7)
Symptomatic (%)	11 (52.3)	10 (66.7)	0.391^b
Preoperative ECOG PS 0 (%)	21 (100)	14 (93.3)	1.000^c
Preoperative metastasis (%)	2 (9.5)	4 (26.7)	0.174^b
Adjuvant immunotherapy (%) Cell type (%)	9 (42.9)	5 (33.3)	0.864^b 0.301^b
Clear	18 (85.7)	13 (86.7)
Non-clear	3 (14.2)	3 (20.0)
Sarcomatoid component	4 (19.0)	1 (6.7)
Fuhrman Grade (%)			0.751^b
2	6 (28.6)	6 (40.0)
3	11 (52.4)	7 (46.7)
4	4 (19.0)	2 (13.3)
Pelvis involvement (%)	10 (47.6)	7 (46.7)	0.955^b
Resection margin involvement (%)	2 (9.5)	1 (6.7)	1.000^c
LN involvement (%)	3 (14.3)	1 (6.7)	0.626^c

ECOG PS: Eastern Cooperative Oncology Group performance status, LN: lymph node

^a : independent-sample t-test,

^b : chi- square test,

^c : Fisher’s exact test

Table 2.

Patients’ characteristics and pathologic results (N0, M0)

	N0, M0			p-value
	pT3a	pT3b	pT3b＋pT 3a	p-value
No. of patients	44	19	11
Age (years)	60.3±11	58.2±12	61.7±12	0.698^a
Sex (male:female)	29:15	14:5	7:4	0.796^b
Tumor size (cm)	6.7±2.2	8.0±2.4	9.4±2.3	0.002^a
Laterality (right:left)	25:19	12:7	7:4	0.854^b
Location (%)				0.479^b
Upper	15 (34.0)	8 (42.1)	5 (45.4)
Mid	11 (25.0)	6 (31.6)	6 (54.5)
Lower	18 (41.0)	7 (36.8)	4 (36.4)
Symptomatic (%)	9 (20.5)	11 (57.9)	8 (72.7)	0.002^b
Preoperative ECOG PS 0 (%)	43 (97.7)	19 (100)	10 (90.9)	0.322^b
Adjuvant immunotherapy (%)	6 (13.6)	7 (36.8)	4 (36.7)	0.069^b
Cell type (%)				0.429^b
Clear	40 (90.9)	16 (84.2)	10 (90.9)
Non-clear	4 (9.1)	3 (15.8)	1 (9.1)
Sarcomatoid component	2 (4.5)	3 (15.8)	1 (9.1)
Fuhrman Grade (%)				0.832^b
2	18 (40.9)	6 (31.6)	3 (27.2)
3	20 (45.4)	10 (52.6)	7 (63.6)
4	6 (13.6)	3 (15.8)	1 (9.1)
Pelvis involvement (%)	21 (47.7)	9 (47.4)	4 (36.3)	0.720^b
Resection margin involvement (%)	1 (2.2)	2 (10.5)	0 (0)	0.348^b

ECOG PS: Eastern Cooperative Oncology Group performance status

^a : one-way ANOVA test,

^b : chi-square test

Table 3.

Multivariate analysis by Cox proportional hazards model in pT3b RCC

Factors	Hazard ratio	95.0% CI	p-value
pT3a	3.707	1.120-12.27	0.032^a
Symptomatic	0.092	0.243-2.815	0.761
Preoperative ECOG PS 0	11.43	5.056-442.3	0.001^a
Preoperative metastasis	45.72	7.371-283.5	0.001^a
Tumor size	0.190	0.763-1.188	0.663
Fuhrman grade	2.404	0.503-11.49	0.272
LN involvement	2.482	0.259-23.76	0.430
Clear cell	3.517	0.599-20.65	0.164

RCC: renal cell carcinoma, CI: confidence interval, ECOG PS: Eastern Cooperative Oncology Group performance status, LN: Lymph node

^a : statistically significant

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