title: Capsular involvement in patients undergoing partial nephrectomy for localized renal cell carcinoma: an adverse pathological finding?
abstract: OBJECTIVE
  To evaluate the prognostic impact of capsular involvement (CaI) in patients treated exclusively with partial nephrectomy (PN) for localized renal cell carcinoma (RCC), as in these patients CaI was recently reported as an adverse prognostic factor.
  
  
  METHODS
  We retrospectively reviewed the medical records of patients treated with PN for a sporadic and localized RCC (pT1-pT2N0M0) in our institution between 1985 and 2005. Univariate and multivariate analysis using a Cox proportional-hazards regression analysis were conducted to identify significant predictors of oncological outcome for several clinical and pathological factors, i.e. imperative indication, histological type, Fuhrman grade, tumour size, T stage, CaI, and surgical margins. Disease-free and -specific survival rates of patients with CaI and no evidence of CaI were compared using the log-rank test.
  
  
  RESULTS
  In all, 305 patients had a PN for localized RCC, of whom 22 (7.2%) had CaI in the PN specimen. The median (range) follow-up was 6 (1.5-23) years. Multivariate statistical analysis showed that imperative indication for PN and high-grade RCC were independently associated with worse disease-free and -specific survival, whereas CaI had no prognostic value. Disease-free and -specific survival in patients with and without CaI were not significantly different at 5 and 10 years.
  
  
  CONCLUSIONS
  In a contemporary series of patients exclusively treated with PN for localized RCC, CaI was not predictive of disease recurrence and disease-specific mortality. These results do not support the use of any change in postoperative management in patients with CaI after PN.
authors.affiliation: Department of Urology, Necker Hospital, Paris, France. yannickrouach@hotmail.com
authors.forename: Yannick
authors.initials: Y
authors.lastname: Rouach
authors.forename: Nicolas
authors.initials: N
authors.lastname: Delongchamps
authors.forename: Marc-Olivier
authors.initials: MO
authors.lastname: Timsit
authors.forename: Virginie
authors.initials: V
authors.lastname: Verkarre
authors.forename: Eric
authors.initials: E
authors.lastname: Fontaine
authors.forename: Mickael
authors.initials: M
authors.lastname: Peyromaure
authors.forename: Arnaud
authors.initials: A
authors.lastname: Mejean
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D004812:Epidemiologic Methods; D006801:Humans; D007668:Kidney / Q000473:pathology*; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009392:Nephrectomy / Q000379:methods*; D011379:Prognosis; D055815:Young Adult