title: Prognostic impact of perirenal fat or adrenal gland involvement in patients with pT3b renal cell carcinoma.
abstract: OBJECTIVE
  To analyze the prognostic impact of the pT3a factors, perirenal fat or adrenal gland involvement, in patients with pT3b renal cell carcinoma (RCC).
  
  
  METHODS
  A total of 43 patients with pT3b RCC who underwent radical nephrectomy, with complete resection of tumor thrombus, at our institution from March 1972 to September 2005 were enrolled in this study. The presence of pT3a factors was reviewed, and the disease-specific survival was compared according to the reclassification as pT3b only or pT3b with pT3a.
  
  
  RESULTS
  After review by a single pathologist, 23 patients (53.5%) were identified as having pT3b only and 20 patients (46.5%) as having pT3b with pT3a. The mean disease-specific survival time in those with pT3b only was significantly longer at 70.9 +/- 9.1 (SE) months compared with 25.0 +/- 4.4 (SE) months in those with pT3b with pT3a (P = 0.0032). On univariate analyses, the presence of pT3a factors (P = 0.0065), preoperative metastasis (P = 0.0025), surgical specimens positive for lymph node metastasis (P = 0.0183), and spindle cell factor (P = 0.0233) were recognized as predictors of a poor prognosis.
  
  
  CONCLUSIONS
  The presence of perirenal fat or adrenal gland involvement in patients with pT3b RCC renders the prognosis significantly worse. Careful postoperative examination should be required, along with reclassification for Stage pT3b with pT3a in RCC.
authors.affiliation: Department of Urology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan. tfujita@cd5.so-net.ne.jp
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Fujita
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Iwamura
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Yanagisawa
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Muramoto
authors.forename: Takahiro
authors.initials: T
authors.lastname: Hirayama
authors.forename: Isao
authors.initials: I
authors.lastname: Okayasu
authors.forename: Shiro
authors.initials: S
authors.lastname: Baba
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D050152:Intra-Abdominal Fat / Q000473:pathology*; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods; D011183:Postoperative Complications / Q000401:mortality; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis