Prognostic Significance of Renal Pelvic and Medullary Invasion in Renal Cell Carcinoma

Yoon, Cheol Yong; Cho, Jae Heung; Yoon, Duck Ki

Abstract

It is well known that many cases of renal cell carcinoma accompanies gross or microscopic hematuria. It implies that much of renal cell carcinoma may also have pelvic or medullary invasion. But unlike other well known prognostic factors such as renal vessel or regional invasion, the prognostic significance of pelvic or medullary invasion in renal cell carcinoma has not been known well. We reviewed retrospectively 73 patients treated with radical nephrectomy in whom 18 patients has pathologically confirmed pelvic or medullary invasion. The mean follow-up duration was about 23 months. The average size of tumor in non-pelvic invasive group (NPIG) was 6.6 cm and in pelvic invasive group (PIG) it was 5.4 cm. In NPIG, 91% (67 patients) of tumor was Grade II and III and in PIG 100% of tumor was Grade II and III. 89% of NPIG tumor was stage pT3aN0M0 or below. And 88% of PIG was pT3aN0M0 or below. At 12 NPIG patients (16%) tumor has recurred and its mean duration was about 6.6 months. In PIG, 5 patients had recurrent tumor (27%) and its duration was about 7.6 months. Nine patients (12.3%) died due to renal cell carcinoma in NPIG. In PIG 3 patients (16%) died of renal cell carcinoma. The study revealed that there is no significant difference between pelvic or medullary invasive and non-pelvic invasive renal cell carcinoma in tumor grade and stage. But in pelvic invasive renal cell carcinoma, relatively more tumor recurrence had occurred (p>0.05) and also relatively more patients died due to tumor. We think that for more proper clarification of prognostic significance of pelvic or medullary invasion in renal cell carcinoma, more long term follow-up and stage by stage study will be needed.