title: Capsular invasion in renal cell carcinoma: a meta-analysis.
abstract: OBJECTIVE
  Capsular invasion is frequently detected in localized renal cell carcinoma (RCCs) samples. Whether patients with localized RCCs and capsular invasion will suffer poorer clinical outcome than those without this pathologic finding is still at issue.
  
  
  METHODS
  We performed a systematic literature research of Central, Medline, Embase, and Chinese database CNKI and VIP. Cohort studies comparing the prognosis in patients with localized RCCs and with or without capsular invasion were included. Incidence of capsular invasion in different Fuhrman grade, primary TNM stage, and clinical outcome were analyzed.
  
  
  RESULTS
  Six cohort studies with 2,295 eligible patients were identified. Capsular invasion was presented in 500 specimens (21.79%). Lower grade (Fuhrman I/II vs. Fuhrman III/IV) and stage (pT1 vs. pT2) diseases were associated with lower incidence of capsular invasion, with OR = 0.56, 95% CI[0.37-0.85] and OR = 0.35, 95% CI[0.25-0.49], respectively. Our pooled analysis showed patients with capsular invasive had 1.80 times the risk of tumor recurrence than patients without these findings (HR = 1.8, 95% CI [1.21, 2.68]), and patients with localized RCCs and capsular invasion were detected at 4.93 times risk in developing cancer related death than those without its presence during follow up (HR = 4.93, 95% CI [2.14, 11.35]).
  
  
  CONCLUSIONS
  Patients with localized RCCs and capsular invasion are of poorer prognosis than those without this finding. Capsular invasion may serve as an additional factor in stratifying patient with localized RCCs.
authors.affiliation: Department of Urology, West China Hospital, Sichuan University, Sichuan, P.R. China.
authors.forename: Turun
authors.initials: T
authors.lastname: Song
authors.forename: Yuan
authors.initials: Y
authors.lastname: Yin
authors.forename: Banghua
authors.initials: B
authors.lastname: Liao
authors.forename: Shuo
authors.initials: S
authors.lastname: Zheng
authors.forename: Qiang
authors.initials: Q
authors.lastname: Wei
mesh_terms: D002292:Carcinoma, Renal Cell / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods; D011379:Prognosis