title: Urinary collecting system invasion reflects adverse long-term outcome and is associated with simultaneous metastatic spread at the time of surgery and with multilocular dissemination during postsurgical follow-up in renal cell cancer.
abstract: OBJECTIVE
  To assess the prognostic implication of urinary collecting system invasion (CSI) in renal cell cancer (RCC).
  
  
  METHODS
  Surveying a mean follow-up of 85 months, we investigated a cohort of 834 patients after radical (n = 710) or partial (n = 124) nephrectomy. At the time of surgery, 63 patients (7.6%) suffered from metastatic RCC. Various histopathologic parameters were analysed, and cancer specific survival (CSS) curves were individualized for each parameter. Furthermore, multivariate analysis was accomplished.
  
  
  RESULTS
  Collecting system invasion was independently associated with a significant decline in CSS and was associated with simultaneous metastatic spread at the time of surgery and multilocular (involvement of at least two different organ systems) dissemination.
  
  
  CONCLUSIONS
  The prognostic implication of CSI in RCC appears to be more complex than expected. Therefore, pathologists should report on CSI to enable selection of patients to be investigated in prospective studies which are needed to clarify the prognostic role of CSI in RCC.
authors.affiliation: Department of Urology, Clinic Weiden, Weiden, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Brookman-Amissah
authors.forename: Matthias
authors.initials: M
authors.lastname: May
authors.forename: Knut
authors.initials: K
authors.lastname: Albrecht
authors.forename: Thomas
authors.initials: T
authors.lastname: Herrmann
authors.forename: Jan
authors.initials: J
authors.lastname: Roigas
authors.forename: Christian Peter
authors.initials: CP
authors.lastname: Gilfrich
authors.forename: Sandra
authors.initials: S
authors.lastname: Pflanz
authors.forename: Sven
authors.initials: S
authors.lastname: Gunia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D007685:Kidney Tubules, Collecting / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009392:Nephrectomy; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult