title: The Prognostic Impact of Tumor Size on Cancer-Specific and Overall Survival Among Patients With Pathologic T3a Renal Cell Carcinoma.
abstract: BACKGROUND
  We aimed to determine the prognostic role of tumor size in patients with stage pT3a renal cell carcinoma (RCC).
  
  
  METHODS
  We analyzed our database of patients who underwent radical nephrectomy for RCC between July 2000 and December 2013. Clinical and pathologic data were obtained for each patient. Patients with stage pT3a disease were divided into 2 subgroups according to the most informative threshold for pathologic tumor dimension that was able to predict survival outcomes (group 1, ≤ 8 cm; group 2, > 8 cm).
  
  
  RESULTS
  Globally, 185 consecutive patients were evaluated. The median (interquartile range [IQR]) follow-up was 32 months (18-62 months). The median (IQR) pathologic tumor size was 7.5 cm (5.7-10 cm). Seventy (34.3%) patients died of RCC during the follow-up period. Patients in group 2 experienced worse cancer-specific survival (CSS) rates compared with those in group 1, (5- and 10- year CSS, 52% and 40% vs. 67% and 63%, respectively; P = .001). Overall survival (OS) rates were significantly lower for patients included in group 2 compared with patients in group 1 (5- and 10- year OS rates, 46% and 38% vs. 60% and 57%, respectively; P = .01). Subgroup stratification (hazard ratio [HR], 3.65; P < .001), presence of positive surgical margins (HR, 3.86; P = .22), high Fuhrman grade (HR, 4.33; P < .001), and the presence of sarcomatoid cells (HR, 2.61; P = .02) were found to be independent predictors of CSS.
  
  
  CONCLUSIONS
  Worse oncologic outcomes are observed in patients with stage pT3a RCC tumors > 8 cm. The current TNM classification still does not precisely correlate with CSS. Tumor size should be taken into account in a future revision of the TNM staging system.
authors.affiliation: Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Schiavina
authors.affiliation: Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy. Electronic address: mark.borghesi1@gmail.com.
authors.forename: Marco
authors.initials: M
authors.lastname: Borghesi
authors.affiliation: Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Chessa
authors.affiliation: Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Hussam
authors.initials: H
authors.lastname: Dababneh
authors.affiliation: Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Bianchi
authors.affiliation: Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Livia
authors.initials: L
authors.lastname: Della Mora
authors.affiliation: Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Del Prete
authors.affiliation: Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Longhi
authors.affiliation: Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Rizzi
authors.affiliation: Department of Pathology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Michelangelo
authors.initials: M
authors.lastname: Fiorentino
authors.affiliation: Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Martorana
authors.affiliation: Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Brunocilla
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D047368:Tumor Burden
keywords: Locally advanced renal cell carcinoma; Radical nephrectomy; Survival; TNM classification; Tumor dimension