title: Urinary collecting system invasion is a predictor for overall and disease-specific survival in locally invasive renal cell carcinoma.
abstract: OBJECTIVE
  To examine the impact of urinary collecting system invasion (UCSI) on survival in patients with pathologic stage T3 renal cell carcinoma (RCC).
  
  
  METHODS
  We identified 1420 patients who underwent nephrectomy at a single institution between 1988 and 2008. Patients with pT3 RCC and data on UCSI were examined (n=303). Clinicopathologic variables were compared using chi-square tests, and a multivariate analysis using the Cox proportional hazards method was used to evaluate the relationship between UCSI and survival.
  
  
  RESULTS
  Of 303 patients with pT3 RCC, 67 (22.1%) had UCSI. UCSI was associated with higher T3 substage, tumor size, lymph node metastasis, and sarcomatoid features, as well as a shorter 5-year overall (51.9% vs 30.4%; P=.003) and disease-specific survival (59% vs 33.9%; P<.001) compared with those without USCI. On multivariate analysis, UCSI was independently associated with overall (HR 1.49; 95% CI, 1.02-2.17) and disease-specific survival (HR 1.76; 95% CI, 1.15-2.68).
  
  
  CONCLUSIONS
  The presence of UCSI is independently associated with higher overall and disease-specific mortality in patients undergoing nephrectomy for pT3 RCC. Locally advanced tumors crossing an additional anatomic boundary into the urinary collecting system appear to represent a particularly aggressive form of disease. These data suggest consideration for including UCSI in the next TNM staging system for RCC.
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232-2765, USA. c.anderson@vanderbilt.edu
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Anderson
authors.forename: Peter E
authors.initials: PE
authors.lastname: Clark
authors.forename: Todd M
authors.initials: TM
authors.lastname: Morgan
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Stratton
authors.forename: S Duke
authors.initials: SD
authors.lastname: Herrell
authors.forename: Rodney
authors.initials: R
authors.lastname: Davis
authors.forename: Michael S
authors.initials: MS
authors.lastname: Cookson
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Smith
authors.forename: Sam S
authors.initials: SS
authors.lastname: Chang
mesh_terms: D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000473:pathology*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology*; D007685:Kidney Tubules, Collecting; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate