title: Pathological Stage T3a Significantly Increases Disease Recurrence across All Tumor Sizes in Renal Cell Carcinoma.
abstract: OBJECTIVE
  Tumor size and stage are important prognostic parameters in renal cell carcinoma. While pathological stage T1 and T2 are defined by size alone, the presence of certain intrinsic features can up stage a tumor to pathological stage T3a regardless of size. We investigate the effect of pathological tumor stage on the relationship between tumor size and risk of disease recurrence.
  
  
  METHODS
  Data were reviewed on patients who underwent nephrectomy at our institution between 2006 and 2013 to identify all those with pathological stage T1, T2 and T3a tumors. A proportional hazards Cox model was built with time to recurrence as outcome, and pathological stage and tumor size as covariates. An interaction term for stage and tumor size was included.
  
  
  RESULTS
  The final cohort included 1,809 patients. On multivariable analysis, when adjusted for tumor size, patients with pT3a tumors had a greater risk of tumor recurrence compared to those with pT1/T2 tumors (HR 3.70; 95% CI 2.31, 5.92; p <0.0001). The risk of disease recurrence increased more rapidly as tumor size increased only with the presence of perinephric fat invasion (p=0.006).
  
  
  CONCLUSIONS
  Using the AJCC 2010 staging criteria we validated pathological stage T3a as a poor prognostic factor in renal cell carcinoma regardless of tumor size. Our results also demonstrated an increased rate of risk of recurrence with perinephric fat invasion. Given this increased risk of recurrence, even in tumors less than 4 cm, closer surveillance is warranted in such cases and the role of perinephric involvement necessitates further investigation.
authors: Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors: Michael
authors: M
authors: Chevinsky
authors: Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors: Mariam
authors: M
authors: Imnadze
authors: Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors: Alexander
authors: A
authors: Sankin
authors: Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors: Andrew
authors: A
authors: Winer
authors: Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors: Roy
authors: R
authors: Mano
authors: Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors: Christopher
authors: C
authors: Jakubowski
authors: Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors: Joseph
authors: J
authors: Mashni
authors: Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.
authors: Daniel D
authors: DD
authors: Sjoberg
authors: Surgical Pathology Diagnostic Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors: Ying-Bei
authors: YB
authors: Chen
authors: Surgical Pathology Diagnostic Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors: Satish K
authors: SK
authors: Tickoo
authors: Surgical Pathology Diagnostic Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors: Victor E
authors: VE
authors: Reuter
authors: Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors: A Ari
authors: AA
authors: Hakimi
authors: Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address: russop@mskcc.org.
authors: Paul
authors: P
authors: Russo
mesh_terms: D002292:Carcinoma, Renal Cell / Q000473:pathology* / Q000601:surgery; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000453:epidemiology*; D009367:Neoplasm Staging; D009392:Nephrectomy; D009518:New York / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D047368:Tumor Burden
keywords: carcinoma; neoplasm staging; recurrence; renal cell