title: Prognostic relevance of tumour size in T3a renal cell carcinoma: a multicentre experience.
abstract: OBJECTIVE
  To evaluate the prognostic role of tumour size in pathological stage T3a renal cell carcinoma (RCC) with fat invasion only and to assess whether this subgroup maintains its relevance over the other pathological stages.
  
  
  METHODS
  We retrospectively studied 2113 patients from eight international institutions who were treated by surgical resection for T2-4 RCC. Disease-specific survival (DSS) was evaluated with univariate and multivariate analyses.
  
  
  RESULTS
  Univariate analysis of patients with T3a RCC showed that tumour size was significantly associated with DSS (HR: 1.09, 95% CI: 1.05-1.12, p<0.001). An ideal cut-off of 7 cm for these patients was identified with a scatter plot of Martingale residuals and tumour size. The two T3a groups were distinctly different with respect to clinicopathologic parameters (performance status, metastases, grade, histological subtype) and survival (p<0.001). Median survival time was not reached for patients with T2 and T3a< or =7 cm disease with a 5- and 10-yr DSS rate of 70% and 59% and 63% and 53%, respectively. Median survival time for patients with T3a>7 cm, T3b, T3c, and T4 disease was 54, 46, 21, and 11 mo, respectively, with 5- and 10-yr DSS rates of 46% and 36%, 46% and 36%, 34% and 0%, and 16% and 14%, respectively.
  
  
  CONCLUSIONS
  Our data indicate that tumour size is an important factor for predicting outcome of patients with T3a RCC with fat invasion only. Our findings should merit consideration during the next revision of the TNM classification.
authors.affiliation: Department of Urology, David Geffen School of Medicine at University of California-Los Angeles, California 90095-1738, USA.
authors.forename: John S
authors.initials: JS
authors.lastname: Lam
authors.forename: Tobias
authors.initials: T
authors.lastname: Klatte
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Patard
authors.forename: Rakhee H
authors.initials: RH
authors.lastname: Goel
authors.forename: François
authors.initials: F
authors.lastname: Guillè
authors.forename: Bernard
authors.initials: B
authors.lastname: Lobel
authors.forename: Clement-Claude
authors.initials: CC
authors.lastname: Abbou
authors.forename: Alexandre
authors.initials: A
authors.lastname: De La Taille
authors.forename: Jacques
authors.initials: J
authors.lastname: Tostain
authors.forename: Luca
authors.initials: L
authors.lastname: Cindolo
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Altieri
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ficarra
authors.forename: Walter
authors.initials: W
authors.lastname: Artibani
authors.forename: Tommaso
authors.initials: T
authors.lastname: Prayer-Galetti
authors.forename: Luigi
authors.initials: L
authors.lastname: Schips
authors.forename: Richard
authors.initials: R
authors.lastname: Zigeuner
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Pantuck
authors.forename: Robert A
authors.initials: RA
authors.lastname: Figlin
authors.forename: Arie S
authors.initials: AS
authors.lastname: Belldegrun
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001317:Austria / Q000453:epidemiology; D002140:California / Q000453:epidemiology; D002292:Carcinoma, Renal Cell / Q000145:classification / Q000401:mortality / Q000473:pathology*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007680:Kidney Neoplasms / Q000145:classification / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013997:Time Factors