title: Impact of renal vein invasion and fat invasion in pT3a renal cell carcinoma.
abstract: OBJECTIVE
  • To evaluate the prognostic impact of tumor fat invasion (FI) and renal vein invasion (RVI) in patients with T3a renal cell carcinoma.
  
  
  METHODS
  • In total, 220 consecutive patients treated for renal cell carcinoma between 1992 and 2009 were analyzed. T3a stage cases were selected. • A single pathologist reviewed all cases.
  
  
  RESULTS
  • The present study cohort included 46 patients with mean follow-up of 28.6 months, of whom 17 (36.9%) died from disease. Patients were initially divided into three groups including 24 (52.1%) of FI only, 11 (23.9%) of RVI only and 11 (23.9%) of both FI and RVI. • In univariate analysis, no significant differences in disease-specific survival (DSS) were noted between FI only and RVI only groups (P= 0.91). DSS was significantly worse in the FI + RVI group compared to the other groups (P= 0.02). • When grouped into FI or RVI vs FI + RVI, DSS remained significantly lower in the group containing the parameters concurrently (P= 0.009). Progression-free survival also was significantly lower in FI + RVI group (P= 0.01). • Metastasis, positive lymph nodes and the presence of FI + RVI remained as isolated predictors of survival. • Patients with FI + RVI presented a 2.6-fold increase in risk of death from cancer and a 2.5-fold increase in risk of disease progression (P= 0.04) compared to those with either of them alone.
  
  
  CONCLUSIONS
  • The isolated or concomitant presence of FI and RVI may be used as one of the criteria for staging in the next edition of the Tumour-Node-Metastasis classification because they have significantly different outcomes.
authors.affiliation: AC Camargo Hospital - Urology, Sao Paulo, Brazil. waltercosta@hotmail.com
authors.forename: Walter Henriques
authors.initials: WH
authors.lastname: da Costa
authors.forename: Ravendra R
authors.initials: RR
authors.lastname: Moniz
authors.forename: Isabela Werneck
authors.initials: IW
authors.lastname: da Cunha
authors.forename: Francisco Paulo
authors.initials: FP
authors.lastname: Fonseca
authors.forename: Gustavo Cardoso
authors.initials: GC
authors.lastname: Guimaraes
authors.forename: Stênio
authors.initials: S
authors.lastname: de Cássio Zequi
mesh_terms: D000273:Adipose Tissue / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011379:Prognosis; D012082:Renal Veins / Q000473:pathology*; D016896:Treatment Outcome; D019043:Vascular Neoplasms / Q000473:pathology*