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

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

• Lee DW
• Yoo ES
• Kwon TG

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.

Keyword

Renal cell carcinoma; Thrombosis; Fats; Adrenal glands; Prognosis

MeSH Terms

Adrenal Glands
Carcinoma, Renal Cell
Fats
Humans
Multivariate Analysis
Neoplasm Metastasis
Nephrectomy
Prognosis
Proportional Hazards Models
Retrospective Studies
Thrombosis
Fats

Figure

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  Fig. 1. Kaplan-Meier disease-specific survival after nephrectomy (Any N, M).

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  Fig. 2. Kaplan-Meier disease-specific survival after nephrectomy (N0, M0).

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